Tackling the Social Determinants of Health

Tackling the Social Determinants of Health

Many factors influence whether people are healthy or sick. Genetics play an important role in many diseases but sometimes a health issue is just bad luck–a reckless driver causing an accident or a bite by a disease carrying insect can turn a perfectly healthy person into a chronic patient in a matter of seconds.

But for many people the crucial factors that decide – at least in part – their wellbeing are social: availability of nutritious and healthy food, good education that allows a person to get a secure, well-paying and safe job, a home in an area with clean water and air, enough time and money to afford time off, access to vaccinations and screenings, and stable interpersonal relationships. In short, health – or sickness – often start in people’s homes, schools, jobs, and communities.

Healthcare providers recognize the importance of these social determinants of health and the potential to positively impact health outcomes by improving these factors. The high per capita healthcare expenses in the US that do not translate into better health outcomes compared to other developed nations can at least in part be explained by social determinants of health.

Engage The Community

Addressing social issues will not only improve health outcomes but will also save a significant amount of money: A 2016 study by PWC estimated that “relying on an extended care team that includes nutritionists, social workers and community health workers could save providers $1.2 million a year per 10,000 patients in a value-based payment environment.”

For most physician practices or clinics, adding social workers or nutritionists, let alone helping patients with such intractable issues as affordable housing and job security, is beyond what they can reasonably do. Partnering with local organizations that address social issues, like non-profits or churches, is one possible way for health care providers to support their patients with those critical social factors.

Need A Ride?

Often, though, it’s the little things that can make a big difference: like transportation, for example.

In a series of interviews, physicians pinpointed a number of factors they believe would help patients leading healthier lives. Not surprisingly higher incomes, better food, and more affordable housing ranked very high on that list, as did helping patients better understand their healthcare options and the cost associated with these options.

In addition, 66% of the physicians interviewed in this study pointed out that helping patients arrange for transportation to their appointments would make a big difference. Missed appointments– and with that missed access to care– can lead to bad health outcomes. No-shows are also costly for the healthcare provider. Making it easier for patients to get to and from an appointment can be a win-win situation: the patient receives the needed care in a timely fashion, the healthcare provider does not have to work around a gap in their scheduling. For healthcare providers, partnering with companies like Lyft or Uber is an easy way to facilitate patient transport.

Listen to Your Smartphone

Mobile technologies also help to improve health outcomes: 95% of adult Americans now own a cellphone and can easily be reached via mobile apps or SMS. Even people who used to be hard to reach or monitor are now only a text message away from being reminded to take their drugs, schedule a follow-up appointment, see the specialist they were referred to, or adhere to whatever other therapy or treatment the physician prescribed.

The importance of these reminders to boost adherence cannot be overestimated. Patient non-compliance is a huge problem, the WHO estimates that only about 50% of long-term patients in the developed world regularly take their drugs. This adherence problem leads to large amounts of expensive drugs lingering in medicine cabinets while the patients do not improve. Anything that can bump up adherence, such as reminders via smart phones, is bound to have a significant positive effect on health outcomes.

Many factors decide whether is person is healthy or not and social factors play an important role. Though healthcare providers can’t help their patients with many of the really urgent issues such as housing or jobs, even relatively minor changes can make a difference: partnering with a nutritionist to educate people about healthy food choices, organizing transportation to and from appointments or sending patients electronic reminders so they take their drugs and maybe even do those 30 minutes of exercise they promised they would. In a healthcare environment that is more and more value-based even small things that improve health outcomes can make a big difference for the patient and the provider.

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