Two words are spreading in healthcare and they’re having a widespread impact — social determinants. Social determinants of health are the “structural determinants and conditions in which people are born, grow, live, work and age.”1 Essentially, we’re looking at how those conditions impact your daily life. Your health starts at home and in your neighborhood.
For example, in rural America the White House Office of Management and Budget reported the rates of chronic diseases, such as diabetes, COPD and obesity were all higher in those areas than in any other parts of the country. Those health issues can then be looked at when assessing the lower college completion rates and employment growth struggles being dealt with in those areas.2 Now, we in the healthcare industry, have to identify solutions through these conditions.
- What are social determinants?
The idea of social determinants is not new to healthcare, but now the federal government has framework to address the topic. Healthy People 2020 was created to identify strategies to close health gaps in our society because of disparities in racial and ethnic minority, low-income, and other vulnerable communities. The Kaiser Family Foundation outlined items such as economic stability, education and food as some of the influencers of health and wellbeing that have been understood for some time.
In the past, social determinants were seen as a public health issue. In the early 1980’s, many health departments had programs or clinics to address health needs based on social determinants. Through government transformation, public health departments became decentralized and many of the health and wellbeing needs within communities were lost, or addressed by hospitals and other clinical settings. Programs were dependent upon funding. Many programs did not survive through the economic changes of the 1990’s.
- Why is there so much buzz now?
Fast forward to 2017, and social determinants are emerging again as key focal areas. This time the actions being taken are seen again within government, but also now include public and private industries. To answer the question: why now, we need to look to economics and data. Despite annual health expenditures exceeding three trillion dollars in 2016 and health spending growth is expected to boom past five percent this year, health outcomes in the United States continue to fall behind other developed countries.3 Frankly, something has to change in our system of healthcare.
The Affordable Care Act (ACA) raised the bar on how health systems would manage and be reimbursed. Population health seemed to be an answer to minimize risks and costs. The learnings from the early work on population health management are that the approaches were more focused on population medicine. An example would be medical management of a grouping of individuals with diabetes. The management would be a collective approach across an Accountable Care Organization (ACO) or health system. The focus was on the disease and treatment towards the population diagnosed with diabetes.
Dr. Steven Schroeder looked into the health status of Americans as well as population health as a way to improve health. In looking to his research on social determinants, Schroeder and his team identified that care and management of a population had to look further than the disease itself.4 Health and wellbeing is a complex state with multi-focal influencers.
- What does this mean to you?
It means that we cannot continue to deliver care in the same old manner that we always have, we have to look at healthcare differently. Government agencies at the federal, the state and local levels are working together to address population health with an increased focus on social determinants. Insurance companies are also studying and investing in infrastructures to address social determinants such as support of diabetic friendly food banks, housing resources, community walking trails and other broad range actions. In communities across the United States, farm-to-table initiatives are popping up in areas that did not have access to healthy foods. Vans are being designed to be mobile pharmacies bringing much needed medication into locations that do not have a local drug store, or easy public transportation. Social determinants is not a buzzword, it is a movement to change the health of all of us.
That’s why it’s up to us, the professionals in healthcare, to offer solutions to reduce readmissions by creating stronger relationships with our patients through better monitoring, staff training and management.
1. Beyond health care : the role of social determinants in promoting health and health equity. Harry Heiman, Samantha Artiga, Henry J Kaiser Family Foundation, 2015.
2. Social Determinants of Health, https://www.hrsa.gov/advisorycommittees/rural/publications/nac_brief_social_determinants_health.pdf, January 2017.
3. National Health Expenditure Projections 2015-2025. Report can be accessed at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2015.pdf.
4. We Can Do Better — Improving the Health of the American People. http://www.nejm.org/doi/full/10.1056/NEJMsa073350#t=article, The New England Journal of Medicine. 2007.