Internet searches on social determinants of health (SDoH) have reached an all-time high as the COVID-19 pandemic has exacerbated existing health inequities and highlighted systemic and structural racism in healthcare. Evidence of the many ways non-medical factors affect health outcomes is mounting and being supported by governments and global organizations. Healthcare executives should be taking this evidence into account as they create population health strategies that aim to equitably serve their communities.
The importance of population health programs
Building population health programs that focus on social determinants of health offers clinical and operational advantages, from addressing access barriers to reducing readmissions and costs. Some state Medicaid programs are also incentivizing providers to account for social factors across infrastructure and delivery models.
With up to 55% of health outcomes attributable to a patient’s social, economic and physical environment, healthcare leaders must prioritize these factors in their equity efforts.
Five categories of social determinants of health
Here’s an introduction to the five key categories of SDoH and what healthcare systems can do (and are doing) to address them and integrate them into population health strategies.
1. Economic status
Millions of Americans live in poverty, including 1 in 6 children and financial disparities are a very real barrier to healthcare access and outcomes. The inability to pay for not only emergency procedures, but also the regular preventive services that wealthier patients and providers take for granted, drives the risk for chronic disease and mental health concerns and lowers life expectancy.
Financial assistance programs are one tool systems use to address these gaps. Clinician education on how poverty affects patients’ health and decision-making can also help providers account for these factors in their approach to care.
2. Education
In a 2018 position statement, the American College of Physicians emphasized that hundreds of thousands of lives have been lost because of unequal access to education, which is closely related to other SDoH such as income instability. A landmark 2013 review explored the complex connections between lower education and higher mortality, and noted that men who did not complete high school had a fourfold higher mortality rate compared to men with 16 years or more of education. The review also found that people with lower levels of education are more vulnerable to death from lung cancer, respiratory diseases, homicide and accidents.
Initiatives that empower, educate and engage patients in learning about their own health are important for meeting patients of all educational levels. The idea of using a “bedside tablet” to show patients interactive educational materials during appointments has been largely successful across settings.
3. Healthcare access
It’s well established that limited access to healthcare — including specialists and mental health providers — creates disparities in care quality and outcomes. Yet, the solutions are far from straightforward. Some patients can’t access health services due to a lack of insurance coverage, while others cannot physically reach services due to limited facilities or clinical specialties in rural areas, a dearth of options for patients with disabilities or a lack of transportation. Still others are driven away by past experiences of racial, gender or other discrimination from providers.
Resolving these challenges requires a mix of need-dependent solutions, from telemedicine and patient outreach to analytics platforms that can harness health data to identify vulnerable populations.
4. Neighborhood factors
This category includes the many risks that surround a person’s everyday life, such as environmental exposure to industrial pollution or secondhand smoke. It also includes violence in the community, both directly and indirectly. Living in an area with high rates of violent incidents reduces a person’s quality of life, and raises their risk for injury and mental health consequences such as post-traumatic stress disorder.
Healthcare systems should prioritize public health and safety initiatives such as free shuttle services to and from facilities and access to mental health services. Since people who are exposed to violence are more likely to be involved in intimate partner violence, providers should also expand screening and resource referrals for domestic violence victims.
5. Social and community support
A patient’s social and community networks have an outsized influence on their individual health in both positive and negative ways. For example, while healthy habits such as exercise and good nutrition can be promoted within friendships, unhealthy behaviors such as excessive alcohol consumption can, too. In general, healthy relationships drive wellness.
Policies that promote a sense of community can help narrow social gaps. In tandem with other population health strategies, health systems can help by providing targeted support to patients who may lack social networks, such as children of incarcerated parents or LGBTQ+ seniors.
Using technology to address social determinants of health
Technology is emerging as a way to help healthcare stakeholders understand social determinants of health and create better population health strategies. Z codes can now be used alongside other ICD-10-CM codes to mark and track relevant social factors on a patient’s EHR. For example, a Z59 could prompt a clinician to ask about a patient’s housing situation or chronic health needs related to a history of experiencing homelessness. Other tools include telehealth that expands geographical reach and patient engagement offerings that overcome language barriers or challenges in healthcare literacy.
A clinician’s ability to improve the non-medical context of a patient’s situation is often frustratingly limited. But by accounting for SDoH in organizational plans, systems can work to overcome disparities for better care, everywhere.
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