Why addressing the socioeconomic determinants of health will help shape healthcare delivery and patient care
Why addressing the socioeconomic determinants of health will help shape healthcare delivery and patient care9 November 2022 | 8min
Socioeconomic determinants such as income, location, and education level can affect the health and health outcomes of a population
The healthcare industry is only beginning to explore how addressing social determinants of health may lead to improved value for patients and health systems
Leveraging healthcare data and expanding the use of technology are examples of ways healthcare organizations can help reduce the impact of these socioeconomic factors on patient outcomes
Experts envision that in the next 10 – 20 years, what we see today as “healthcare” will no longer be recognizable.1 It will be subject to complete remodeling driven by medical and technological innovation fueled by pressures to improve affordability and access to care while delivering a patient experience in line with our changing attitudes and behaviors towards health. As we reimagine the healthcare systems of the (near) future, socioeconomic determinants of health are gaining traction as a focal area that can significantly affect patient health and outcomes.2
When it comes to the innovation efforts aimed to remedy unsustainability across healthcare systems today, tech-based solutions such as the use of artificial intelligence to improve efficiency and/or to deliver more personalized care seem to take the spotlight. However beneficial and necessary these solutions may be, they tend to overshadow the need to also address socioeconomic factors.
These socioeconomic forces within the greater society exert a massive impact on people’s health, well-being, and quality of life.3 Any comprehensive healthcare system of the future should consider these factors, which encouragingly, is already happening today.
What are the socioeconomic determinants of health?
Numerous studies look into how social and economic factors affect the health and health outcomes of a population. Despite the diversity in factors and outcomes examined, the socioeconomic determinants of health can be described as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”2,3
These socioeconomic determinants of health (or social determinants of health (SDOH) as defined by the US Department of Health and Human Science) can be grouped into five broad categories: economic stability, access to quality education, access to quality healthcare, the neighborhood you live in, and the social connections within the community.2,3 Some examples for each of these categories:
The implications of socioeconomic factors on our health
Recent trends in healthcare aimed at improving patient outcomes have been largely focused on improving the efficiency of the healthcare system to produce better results. However, much of this work overlooks the social differences between patients, and the tremendous impact these can have on their health outcomes.
These non-health-related factors directly affect hospitalization and emergency department use, patient readmission, and chronic disease management.9 Research has demonstrated time and time again that lower socioeconomic status impacts cardiovascular disease,10-12 obesity rates,13 and the quality of sleep14 among others.
Despite the implications of this data, individual patients are unlikely to be able to directly control many of these social determinants because they frame the context of their lives.15 And, because they exist outside the healthcare ecosystem per se, addressing these socioeconomic factors may not always be included in the conversation when healthcare companies are exploring ways to streamline and improve healthcare systems and delivery. For these reasons, the healthcare industry is only beginning to explore incorporating social determinants when looking for ways to drive improved value for patients and systems.
What is being done today?
Recognizing the importance of addressing socioeconomic determinants as crucial to improving health overall, the World Health Organization (WHO) created the Department of Social Determinants of Health to lead its efforts to tackle the social, physical, and economic conditions in society that impact health. The goal is to generate more evidence on how best to address SDOH and build capacities and advocate for accelerated action among member states.16 A new initiative launched by the WHO aims to study SDOH and potential interventions to improve them for at least 20 million disadvantaged people in at least 12 countries by 2028.17
In North Carolina, NCCARE360 is the first statewide coordinated care network attempting to connect those with identified needs to more than 1,100 community resources, helping people to better navigate services like health, housing, employment, and transportation.18 NCCARE360 uses shared technology to enable a coordinated, community-oriented, person-centered approach to delivering care. The goal is to create connections between healthcare and community providers and to provide the tools required to manage these connections and close the loop to track referrals and outcomes.18
Kaiser Permanente, an American managed care group, began working with startup Unite Us to create a social platform to help link their 12.3 million patients with local services to help address socioeconomic determinants of health. Called Thrive Local, this care network links healthcare providers with community services such as housing, food, or transportation, allowing healthcare workers to match an individual’s social needs with the right services, whether nonprofit, public, or private.19
Oak Street Health, which operates primary care clinics focused on Medicare beneficiaries, also opened locations in underserved areas. By embedding in communities, the practice can better address elderly patients’ nonmedical needs. To do so, these centers offer supplemental services such as transportation to and from appointments, classes on Medicare and behavioral health guidance, and activities to combat social isolation.20
How leaders can help provide solutions that address the socioeconomic determinants of health
Despite seeming challenging to address for healthcare organizations, there are ways that leaders can incorporate socioeconomic factors into their planning, processes, tools, and solutions. Some possible actions to consider:
1) Leverage healthcare data. The healthcare industry has critical real-world data at its fingertips that can provide valuable insights into the socioeconomic factors that influence health. Better collecting and analyzing this data can help provide important insights that can help outline the best path forward, allowing companies to target patient populations with beneficial interventions or provide more personalized product/service offerings based on their socioeconomic circumstances as well as their health.
For example, Rush University in Chicago added a socioeconomic determinants of health screening tool within their electronic health record (EHR). The EHR combines the social data with the patient’s medical history to create a patient profile which can be used to identify and generate a curated list of resources and services that match the patient’s needs.21
2) Expand the use of technology. Technology can act as a great leveler in driving more equal access to healthcare. This is especially important for people who are less mobile, live in rural areas, or areas poorly served by existing healthcare infrastructure. The use of digital tools – such as telemedicine, remote diagnosis, and point of care devices – can help eliminate some of the barriers that prevent these underserved groups from accessing the healthcare resources they need. The Department of Veterans Affairs in the US, for example, has created project “Atlas”, which provides equipment for remote telehealth exam rooms for veterans who live in rural areas and don’t have easy access to VA medical facilities.22
3) Consider flexible or differential pricing to drive affordability. In many parts of the world, a large portion of the population must pay out of pocket for some or all medical expenses.23 And almost 13% of the world’s population spent more than 10% of its household income on medical care in 2017.24 This can put many therapies and healthcare services out of reach for large numbers of people. Creating flexible pricing schemes can help alleviate this, and many pharmaceutical and diagnostics companies already do this with their innovative solutions,25-27 For example, a program where verified low-income patients are given a discount based on their financial status can help improve access for poorer patients, without impacting the price for patients able to pay out of pocket.
4) Support preventive educational programs in areas of need. To overcome the lack of awareness and knowledge around health, especially in poorer, rural areas, healthcare companies can support initiatives designed to educate local populations. These should be carefully built, generally using trusted, local health educators to teach communities about health-related issues by hosting educational meetings. These kinds of efforts can not only create positive health-seeking behavior in the community by cementing prevention efforts into daily life, but also generate awareness about disease recognition and treatment. This has been done successfully in India, for example, where locally recruited health educators are trained to increase awareness about diseases and preventative health, while health supervisors ensure medicines are available and accessible even in remote areas.28
Simone Edelmann, PhD is an editor and contributor at HealthcareTransformers.com. After completing her PhD from the Institute of Biotechnology at the University of Lausanne, Switzerland, she found her passion in medical and scientific communications. She is dedicated to delivering high-quality content on the topic of the future of healthcare to our readers.
- Deloitte. (2022). Article available at https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/future-of-health.html [Accessed October 2022]
- Braveman P and Gottlieb L. (2014). Public Health Reports 129(Suppl 2), 19-31
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/priority-areas/social-determinants-health [Accessed October 2022]
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/economic-stability [Accessed October 2022]
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/education-access-and-quality [Accessed October 2022]
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/health-care-access-and-quality [Accessed October 2022]
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/neighborhood-and-built-environment [Accessed October 2022]
- US Department of Health & Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030. Website available at https://health.gov/healthypeople/objectives-and-data/browse-objectives/social-and-community-context [Accessed October 2022]
- Pittman T. (2020). Duke Health. Article available at https://physicians.dukehealth.org/articles/socioeconomic-factors-play-significant-role-health-outcomes [Accessed October 2022]
- Schultz W et al. (2018). Circulation 137, 2166–78
- Franks P et al. (2011). BMC Cardiovascular Disorders 11, 28
- Gebreab S et al. (2015). Journal of the American Heart Association 4, e001553
- Akil L and Anwar Ahmad H. (2011). Ethnicity & Disease 21, 58-62
- Tuck (2021). Article available at https://www.tuck.com/sleep/the-inequality-of-sleep/ [Accessed October 2022]
- World Health Organization. (2017) Website available at https://www.who.int/news-room/questions-and-answers/item/determinants-of-health [Accessed October 2022]
- World Health Organization (2017) Department of Social Determinants of Health. Website available at https://www.who.int/teams/social-determinants-of-health/about [Accessed October 2022]
- World Health Organization. (2022) Website available at https://www.who.int/initiatives/action-on-the-social-determinants-of-health-for-advancing-equity [Accessed October 2022]
- NCCare360. (2022). Website available at https://nccare360.org/ [Accessed October 2022]
- Landi H. (2019). Fierce Healthcare. Article available at https://www.fiercehealthcare.com/hospitals-health-systems/kaiser-permanente-launches-social-health-network [Accessed October 2022]
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- Landi H. (2018). Healthcare Innovation. Article available at https://www.hcinnovationgroup.com/population-health-management/article/13030685/putting-social-determinants-of-health-data-into-action [Accessed October 2022]
- Graham S. (2019). US Department of Veterans Affairs. Article available at https://news.va.gov/64675/project-atlas-creates-better-access-to-care-for-veterans/ [Accessed October 2022]
- World Health Organization. (2022). Global Health Expenditure database available at https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?view=map [Accessed October 2022]
- World Health Organization and World Bank (2021). Global Monitoring Report on Financial Protection in Health database available at https://data.worldbank.org/indicator/SH.UHC.OOPC.10.ZS?end=2017&start=2000&view=chart [Accessed November 2022]
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