Social Determinants of Health

In addition to our genes and lifestyle choices, our health is also determined by a range of personal, social, economic, and environmental factors. These conditions include the quality of our education, access to economic opportunities, the resources in our communities, the cleanliness of our environment, and how safe we are at work and at home.

 

The World Health Organization defines these factors, or social determinants of health (SDOH), as “the conditions in which people are born, grow, live, work, and age. …These circumstances are shaped by the distribution of money, power, and resources at global, national and local levels.”  They help explain, in part, why some people are healthier than others, and they play a critical role in some of the major population health issues that we face today, from depression to diabetes to obesity to heart disease. 

 

Other SDOH include:

• Gender

• Race

• Lack of access to healthy food

• Childhood development

• Community and social support

• Exposure to higher rates of violence and crime

• Lack of available transportation

• Poor neighborhood/environment conditions

• Fewer options for parks/recreation, team sports, community centers

 

 

Here’s the loop that exists: Employment is impacted by health and education. This then creates a challenge with earning potential. A lower earning threshold creates barriers to quality healthcare and healthy food options. Adversity then follows which causes stress and from there depression, overeating, possible substance abuse, etc…

 

 

How Are Healthcare Leaders Addressing The Social Determinants Of Health?

Since the ACA began moving healthcare from fee-based compensation to outcome-based compensation and expanded access to millions of high-risk Americans previously sidelined from preventative and primary care, healthcare leaders have been progressively shifting toward increasing health equity and addressing the paradigm shift towards population health by attending to the social determinants of health.

 

Indeed, healthcare leaders are increasingly aware of the data and research which indicates that the social determinants of health have a higher impact on population health than healthcare and that a higher ratio of social service spending versus healthcare spending results in improved population health. In fact, according to a study published by the National Center for Biotechnology Information, states that allocate more resources to social services than to medical expenditures have substantially improved health outcomes over states that do not. The study found that states that provide higher levels of social services are outperforming their counterparts in areas such as obesity, asthma, mental health, cancer, myocardial infarction, and type 2 diabetes.

 

In tackling the social determinants of health, providers are partnering with community organizations to improve access to housing, healthy food, education, job training, transportation and more. Countless initiatives are underway. Here, we highlight two inspiring examples.

 

Collaborative Care Teams And Authentic Healing Relationships

In the high-poverty city of Camden, New Jersey, residents have struggled to access services for behavioral, social, and medical care and consequently end up in emergency rooms instead. To counter this problem, the Camden Coalition of Healthcare Providers are using data to identify frequent consumers of emergency care and then connect them to a team of primary care providers, nurses, social workers, and behavioral health specialists. These care providers develop “authentic healing relationships” with patients to address their complicated health needs and social requirements through proactive primary care and social services rather than costly emergency department visits. According to Camden Coalition’s coach manual, “The Authentic Healing Relationship is a respectful, trusting and non-judgmental partnership between the Care Team and the patient that serves as the foundation for progress toward long-term health management.” The team strives to empower patients to take ownership of their health and help them to build support networks through community organizations as well as friends and family.

 

Healthy Neighborhoods Healthy Families

One of the most inspirational and far-reaching provider-based programs developed to provide SDOH solutions is Nationwide Children’s Hospital’s Healthy Neighborhoods Healthy Families (HNHF) initiative. Nationwide Children’s has partnered with multiple community partners to tackle five high-impact social determinants: affordable housing, education, health and wellness, safe and accessible neighborhoods, and workforce development. To promote access to affordable housing, they have partnered with Healthy Homes to revitalize local communities through renovation, energy efficiency and green living projects, and repair and maintenance grants to homeowners. They also offer low-income housing to families where residents can participate in on-site classes that provide training targeted toward local job openings and career success skills. They are also tackling challenges in education with kindergarten readiness, mentoring, and STEM programs. Along with the Ronald McDonald House, they have created a mobile care center to provide pediatric primary care including immunizations, developmental screenings, teen health education, and well-child and sick visits. These are just a few of Nationwide Children’s SDOH ambitious undertakings.

Scientific Sources Citations:https://www.cdc.gov/socialdeterminants/index.htm

https://www.who.int/social_determinants/en/

Email Post Blurb:What are the SDOH? These are circumstances, very complex when broken down, in which people live and are born into that affect their health. These include factors that might not be tangible, such as cultural, political and socioeconomic, as well as community/neighborhood based settings like accessible healthcare, schools, safe surroundings, and healthy food options.