When understanding the underlying causes of poor health, it’s imperative to consider social determinants of health (SDoH). Factors such as safe housing, transportation, income, social support, gender, and education can tremendously impact a person’s access to quality care.
These factors are deeply embedded in our everyday lives, and it’s often a combination of factors that may affect a single person.
Here are a few examples of how social determinants of health can impact healthcare access and outcomes:
- Example 1: Jonah does not own a car and takes public transportation to work each day. He's been having health issues and is looking for three primary care physicians in his insurance network within a 20-mile radius. None of them are on a bus route, so he would have to take a taxi costing at least $70 round trip.
- Example 2: Sonia speaks several languages; however, English is not her strongest, so understanding the instructions on her medication is challenging. She asked her doctor’s office if anyone spoke her language, but they didn't. So she does her best and thinks she understands the instructions but takes her medication incorrectly and does not get its full benefit.
- Example 3: David lives in a neighborhood with contaminated water and wonders if his persistent cough is a result. It’s been two years, and the city continues to say they are looking into it but have not taken action. His neighborhood is the only area where he can afford rent. He does not want to move to another city.
So what happens next?
In many cases, care is delayed — put off for another day when circumstances are better. In the meantime, health conditions get worse, more complex, and costlier. When people don’t get the care they need, when they need it, it’s a lose-lose situation for both the individual and the community.
Growing interest in social determinants of health
By now, you can see why addressing social determinants of health is essential. But why has the healthcare industry become interested and started investing in improving these factors for their patients? In addition to it being the right thing to do, it’s also become important to the bottom line for health systems, physician practices, insurance companies, employers, and other organizations. They have realized that healthier people are more productive and less costly in the long run.
Remember that saying, “An ounce of prevention is worth a pound of cure,” from Benjamin Franklin? We’re finally making a shift in that direction. The movers and shakers of the healthcare industry are paying attention.
Value-based care and payment models
But why would a hospital or insurance company invest in social determinants of health? The Affordable Care Act has catalyzed value-based care, creating the first model called an Affordable Care Organization (ACO). An ACO is a group of healthcare providers coordinating care for patients with a specific type of insurance. They are incentivized by keeping a population healthy and paid by the quality of care, not the number of patients seen. For example, a surgeon may get a portion of their payment only if the patient does not get readmitted for an infection within 30 days. Measuring quality is tricky and not as straightforward as a fee-for-service model, but it’s a great start.
Collecting the data and building a strategy
Identifying vulnerable groups in your population is the first step to building a community health strategy that integrates social determinants of health. Maybe it’s single mothers, isolated seniors, children with disabilities, factory workers or farmers, indigenous youth, or those with complex chronic conditions — go ahead and take a deep dive into your population to think about what challenges these people face, what the root cause is, and how they can be solved.
Where can you collect data? Electronic health records, insurance claims, prescription fills, pre-authorizations, and the latest census could be great sources. Many organizations are using zip codes to identify vulnerable populations. They can tell about socioeconomic status.
Putting your strategy to work
Several efforts have been made to address social determinants of health, such as free meal programs, partnerships with food banks, renovation of vacant buildings to become stable housing, and partnerships with community groups for social, caregiving, or transportation support.
The community can have a significant effect on public health. Many community groups and leaders have a strong interest in public health and building a “clinical-community partnership”. This could be carried out in numerous ways, including adding bike lanes, low-cost daycare, farmer’s markets, green spaces, and playgrounds, or banning soda machines.
It may take creative thinking, partnerships, and hard work, but for many of these people affected by social determinants of health, every little bit helps. People want to be healthy; they just need the care to be more accessible in a realistic way.