As healthcare moves toward value-based models which incentivize positive results rather than individual procedures and treatments, providers increasingly are regarding the social determinants of health as critical components of these efforts.  By concentrating on these facets of wellbeing in tandem with medical care, they are taking a holistic view of patients and overall population health to enhance patient care, promote superior outcomes, and drive value in healthcare organizations.

 

What are the Social Determinants of Health?

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The social determinants of health consist of the health systems to which individuals have access and the political, socioeconomic, cultural, and environmental conditions into which they are born and live, all of which impact health and wellbeing.  These social circumstances create societal stratification and are responsible for health inequities among different groups of people based on social class, gender, and ethnicity.  The social determinants of health definitionSL3  put forth by the World Health Organization (WHO) is, “The conditions in which people are born, grow, live, work and age.”  The organization further states that “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels1.” 

 

Complex interactions and feedback loops exist among the social determinants of health4.  For example, poor health can impact employment which in turn constrains income.  Low income reduces access to healthcare and nutritious food and increases hardship.  Hardship causes stress which in turn promotes unhealthy coping mechanisms such as substance abuse and overeating of unhealthy foods.

 

Social Determinants of Health ListSL4 

Social determinants of health are a subset of determinants of health. Governmental policies, availability of healthcare, behavioral choices, and biological and genetic factors are other determinants of health2.  The social determinants of health include:

 

1.       Income level

2.       Educational opportunities

3.       Occupation, employment status, and workplace safety

4.       Gender inequity

5.       Racial segregation

6.       Food insecurity and deficit of nutritious food choices

7.       Access to housing and utility services

8.       Early childhood experiences and development

9.       Social support and community inclusivity

10.    Crime rates and exposure to violent behavior

11.    Availability of transportation

12.    Neighborhood conditions and physical environment

13.    Access to safe drinking water, clean air, and toxin-free environments

14.    Recreational and leisure opportunities

 

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 who previously were sidelined from preventative and primary care, healthcare leaders have been progressively shifting toward increasing health equity by attending to the social determinants of health.

 

Indeed, healthcare leaders are 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, states that allocate more resources to social services than to medical expenditures have substantially improved health outcomes over states that do not.  States that provide higher levels of social services are outperforming their counterparts in areas such as obesity, mental health, cancer, myocardial infarction, and type 2 diabetes7. 

 

To tackle 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 specialists9.  They 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 visits8.  According to Camden Coalitions coaching 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 that tackles SDOH is Nationwide Children’s Hospital’s Healthy Neighborhoods Healthy Families (HNHF) initiative6.  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 ventures.

 

PRAPARE:  Assessing Social Determinants of Health in your Patient Population

An important first step providers can take is to learn about the population health of the communities they serve.  One resource for doing so is the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) from the National Association of Community Health Centers (NACHC).  PRAPARE provides an implementation and action toolkit that is being used by providers nation-wide to gather data that will allow them to assess their patients’ social needs so they can take measures to address them.  Their evaluation tool asks social health questionsSL5  in areas ranging from demographic data and housing status to social-emotional health and physical security.  Another key resource for providers is Health Lead’s Social Needs Screening Toolkit.  Health Leads, a trailblazer in the movement to address the social determinants of health, created this kit to help healthcare leaders develop an assessment tailored to their population needs.

 

Conclusion

More and more, healthcare leaders are positioning their organizations to undertake the social and moral imperative to reduce health inequity by focusing on the social determinants of health.  Through creative partnerships, population health assessment, and new payor models, they are innovating to improve the health and quality of life of their community’s most underserved residents.

 SL1Volume = 8100

 SL2Volume = 320

 SL3Volume = 320

 SL4Volume 90

 SL5Search volume = 40, Keyword difficulty = 72.1.