- Policy and wellness interventions addressing the social determinants of health (SDOH) at California-based Kaiser Permanente improved health outcomes for the health system’s communities, showed a series of studies published as an extension to the American Journal of Preventive Medicine.
Healthcare organizations across the country have been working to address the SDOH, which include factors such as socioeconomic status, race, educational attainment, neighborhood and environment, public safety, food security, and other elements of patients’ everyday living.
Kaiser Permanente’s Healthy Eating Active Living (HEAL) program targeted the SDOH that increased obesity risk in the health system’s patient population. During the ten-year test period, these programs impacted 60 communities and 715,000 individuals across the five states the health system serves, the series of 11 studies revealed. These programs reached both Kaiser Permanente patients and those who are not treated by the health system.
Specifically, these programs targeted healthy eating patient education, programs to increase physical activity, healthier school lunches, increasing food security, and better physical activity education programs in public schools.
Sixty-nine percent of the 143 obesity prevention strategies showed signs of positive individual behavior change, the researchers reported. The most effective strategies for youth included physical education in schools, active recess, Safe Routes to School to allow children to walk or bike to school, and cafeteria modification.
Effective strategies for adults included physical activity initiatives and enhancements in public parks and spaces.
When looking at raw data for improvements in four health areas – physical activity minutes, eating of fruits and vegetables, drinking of sugary drinks, and eating healthier snacks – results were modest or negligible, the researchers said.
However, further analysis revealed that “dose” or potency of a certain initiative made a significant impact on effectiveness. When initiative leaders focused more on broader populations, wellness interventions yielded better results.
For example, physical activity programs in schools were the most successful initiatives. Forty percent of communities had increases in minutes of youth physical activity that may be attributable to Kaiser Permanente’s initiatives.
Other key findings suggested that community health programs be more flexible and address other SDOH that do not have a clear-cut correlation to obesity prevention. Programs targeting public safety and violence, for example, are also important to creating more community wellness.
Additionally, community health programs need to influence overall policy changes in order to create lasting results. Community health programs hosted exclusively by hospitals and their partners are commendable. However, if community changes do not result in policy changes – for example, a program offering healthier school lunches becoming a public school mandate – there is little guarantee they will have lasting results.
A total of 51 percent of the studied Kaiser Permanente programs resulted in overarching policy changes, the reports indicated.
Kaiser Permanente focused on obesity prevention because that was a pressing wellness issue for the organization’s population and all patients across the country, research leaders said.
“In the early 2000s, the problem of obesity was already well recognized and rising to the top of the public health agenda,” the research team leaders wrote in an introduction to the supplement. “The risks of obesity to health are clear: life-threatening and chronic illnesses that shorten life spans, reductions in quality of life, and contributions to healthcare cost inflation that are crowding out other critical social investments. Rates of obesity and the consequences for health are especially high in low-income communities of color.”
Going forward, these study results may be helpful for other healthcare organizations working to implement strategies to address the social determinants of health, said Kaiser Permanente vice president for community health Loel Solomon, PhD.
“These studies provide important insights from a decade of innovative, community-wide efforts to stem the obesity epidemic,” Solomon said in a statement. “They show what it takes to create meaningful, lasting change. The lessons we’ve learned are as valuable as they are timely, because our work is far from done.”
Kaiser Permanente has been at the forefront of addressing the social determinants of health using community-oriented strategies. The organization is also a leader in developing and deploying community health needs assessments (CHNAs), IRS-mandated assessments that analyze patients’ social needs in a non-profit hospital’s service area.
These efforts align with the nation’s continued focus on the social determinants of health. Although SDOH include elements that extend outside the four walls of the hospital, they are still integral for patient health. With the emergence of more value-based care models, healthcare organizations and payers are realizing their responsibility for addressing SDOH in patients.