People are the product of their environment — beyond attitudes, perceptions, personalities and skills, physical manifestations also impact their health and wellness. But for too long, medical practitioners have done little to account for these social and environmental factors that influence our health.
In recent years, as technology has become more ubiquitous in healthcare, as in all other areas of modern life, healthcare has taken a more progressive approach. Data collected from patients, medical devices and mobile health applications yield greater insight into the factors that drive health on a population level. This analysis is often referred to as Social Determinants of Health (SDoH), and it’s something that remains an area of opportunity and exploration in healthcare.
COVID-19 has provided yet another opportunity to examine how SDoH can be applied to help improve care outcomes for certain communities. However, healthcare’s adoption and implementation of technology do not follow a similar path or timeline as other industries; things move slower as the challenges often involve someone’s life.
Simply attributing health to the environment that we exist in isn’t quite as scientifically rigorous as you might imagine. The process requires classifications, categories and informational architecture to understand and develop hypotheses around. Broadly speaking, social determinants of health represent the conditions in which we are born, grow, live, work and age. They are generally broken into the following categories:
- Economic stability: employment, income, debt, expenses, etc.
- Physical environment: neighborhoods, housing, transportation, parks, playgrounds, etc.
- Food: food security, access to healthy food
- Education: literacy, language, pre-K, vocational schools, access to higher education
- Community: support systems, exposure to violence or trauma, policing, stress, social integration
- Healthcare: insurance coverage, doctor and pharmacy availability, culturally appropriate care, quality of care
All these factors combined influence mortality, healthcare costs, life expectancy, morbidity and healthy function.
A Foundation for SDoH
The concepts of social determinants are nothing new and have been an area of study for several years now. However, their application isn’t widespread enough to make a difference in how healthcare providers approach care for diverse communities and how public health organizations create and implement policies addressing social issues tied to health.
According to the American College of Obstetricians and Gynecologists, the following recommendations are things all healthcare providers need to incorporate into their cultures to improve patient-centered care and decrease inequity:
- Documenting social and structural determinants of health: access to healthcare, housing, access to food and clean drinking water, utilities, home safety, immigration status and employment conditions
- Commitment to helping patients use social services – As a key player in crisis intervention, healthcare workers can help identify issues that can be addressed through social services and refer patients to the correct agency.
- Access to interpreters – America’s diversity means healthcare workers encounter people from all backgrounds. To ensure the same standard of care is delivered to all patients, there needs to be a person or technology present that can bridge potential linguistic gaps between patient and physician.
- Eliminate cultural stereotypes – Presumed beliefs about a person because of nationality or ethnic background can detriment the quality of care a patient receives.
- Promote safe and healthy living conditions – Healthcare organizations have a certain level of credibility with patients when trauma and turmoil are present in the person’s life. Education around safe and healthy living conditions and connection with social services can help improve patients’ lives and mitigate future health-related issues.
Putting the Data to Use
The U.S. Department of Health and Human Services has created its Healthy People 2030 initiative that provides data-driven goals for the health and well-being of the national population over the coming decade.
SDoH is an entire subsection of the initiative with specific goals tied to economic stability, quality of and access to education and healthcare, neighborhood and built environments, and social and community contexts.
For example, under Social and Community, the list of objectives includes:
- Reduce anxiety and depression in family caregivers of people with disabilities
- Reduce the proportion of children with a parent or guardian who has served time in prison
- Reduce bullying of transgender students
- Eliminate food insecurity in children
- Reduce the proportion of people with intellectual or developmental disabilities who live in institutional settings with seven or more people.
This list is not exhaustive but shows key areas where public health agencies and care providers’ approaches to SDoH can make a difference in the lives of a diverse population.
Courtesy of technology and the interconnected nature of our lives to devices and the systems they operate in, the data is there to identify where improvements are needed, develop actions that will improve population health, and measure the effectiveness. The more public health agencies and healthcare organizations invest in SDoH, the sooner we move toward a more equitable health landscape.