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Social Determinants of Health: Why 90% of Patient Well-Being has Nothing to do with Healthcare

Whether it's politicians in the nation's capital or doctors in small rural hospitals, most discussions about patient well-being seem to revolve around access to care. While healthcare delivery is very important, research suggests that a wide range of social factors also have a crucial impact on overall patient qualify of life. The United States spends more on health care than any other developed nation but has some of the lowest outcomes in terms of coverage and life expectancy. Fortunately, there's a growing trend among industry experts to bridge the health care delivery system with community health programs that address many different non-medical social issues.

Female biker cycling in countryside forest

How Social Factors Affect Health

The social factors that affect the overall health of an individual include conditions of birth and growth as well as physical environment, economic status, location, and social network. According to a meta-analysis by the American Journal of Public Health, poverty, racial segregation and education account for more than one out of three deaths. Lower income American are more likely to experience poor sanitation, hunger, violence, and lack of recreational resources. In addition, evidence suggests that living in these types of stressful conditions deteriorates health for both children and adults. These types of environmental conditions have multi-generational impacts.

Groups that have historically experienced greater systemic obstacles are most affected by social detriments to health. Religious, racial and ethnic minorities, low-income families and individuals, and people who identify as LGBTQ typically experience lower qualities of life. In order to achieve better health outcomes for all Americans, addressing these social issues is essential. There are two main approaches to solving this problem: broad population-based strategies and targeted efforts that deal with specific communities and groups of people. In recent years, a growing number of initiatives using both types of solutions have sprung up in all parts of the country.

Location-Based Approaches and Mapping

Using mapping and geospatial analysis to evaluate health dates back more than 150 years. Today, it's well understood among professionals that zip code is a better predictor of health than genetic code. That's why many social initiatives designed to improve health outcome are being focused on specific neighborhoods that face numerous obstacles. In Camden, NJ, a city that sees a high amount of emergency visits for preventable conditions, the Camden Coalition of Health Care Providers uses social workers to connect individuals and families with programs and resources. So far, emergency room use is down and health conditions have improved.

Initiatives have also started in many other locations throughout the country. In New York City the The Harlem Children’s Zone (HCZ) Project strives to improve health outcomes in the community with "a broad range of family, social service, and health programs." The Colorado Health Foundation is directing an effort to improve access to physical recreation in order to lower obesity levels. In more than 30 states, the Healthy Food Financing Initiative has brought access to more healthy foods for low-income communities. Both health and economic conditions have improved in these areas.

Health in All Policies

Local initiatives have big impacts on specific communities, but policy makers at big organizations have the potential to shift health outcomes for millions of people at a time. Health in All Policies is a movement that encourages policy makers at all levels, both public and private, to consider health outcomes when making decisions. This initiative, which has gained strength since the early 2000s, works in a wide range of sectors, including education, transportation, community development, and agriculture. Giving disadvantaged groups better opportunities in all these areas has profound impacts on long-term well-being.

The Health in All Policies initiative is gaining influence in government organizations on a city, state, and and federal level. The National Prevention Council strives to advance health and wellness efforts through collaboration with all federal agencies. In California, an all policies task force was created to improve access to things like healthy food and public transportation. King County in the state of Washington adopted a “fair and just” principle that prioritizes health in everything from transportation to education. Community organizations funded by private parties are also realigning their efforts to focus on an overall culture of health.

Integrating Social Determinants into the Health Care System

State Innovation Models Initiative

A number of states are adopting the State Innovation Models Initiative (SIM) to combat health inequality caused by social factors. Lead and funded by the Center for Medicare and Medicaid Innovation, SIM aims to improve health system access while decreasing costs by helping states develop and test new payment and care delivery models. More than half the states in the nation have already received grants from the initiative, and a new rewards program plans to direct funds towards states that develop plans to improve population health statewide.

Payment and Delivery Reforms in Medicare

Medicaid already connects many under served communities with medical services they need, but a new focus on integrating health care delivery with social solutions may improve outcomes further. In both Colorado and Oregon, organizations are working to coordinate and improve behavioral, physical, and social services while promoting greater community engagement. The ACA allows Medicaid programs to create health homes for individuals suffering from chronic conditions, and more recently, recognition that housing has an affect on health has caused many states to incorporate housing solutions for many people in need. While Medicaid funds can't directly fund room and board, they can be used to support referrals, support, and case management services.

Provider and Health Plan Efforts

Community health centers (CHC) will be one of the key components to addressing social detriments to health outcomes because they are already positioned to serve at need communities. The National Association for Community Health Centers and many other organizations have partnered up to test and implement new programs that address this issue. Clinicians assess the health impacts of social status on individuals and them connect them with the community resources they need to improve. Even some health insurance plans have integrated social factors into their policies by providing for food, education, and other services.

Looking Ahead

While public and private organizations are doing more than ever to address social detriments to health, much more needs to be done to improve the well being of all populations. Going forward, learning from existing initiatives while continuing to approach care delivery from a broad social context will be crucial.