- The social determinants of health are the factors that affect health outside of the four walls of the hospital. Housing, social services, geographical location, and education are some of the most common social determinants of health.
These factors have a significant impact on the current healthcare landscape. As more healthcare organizations deliver value-based healthcare, they are developing strategies to drive wellness care.
Organizations are catering to patient needs outside of the hospital with the goal of keeping patients healthy in the long-run. Patients who have better health support in their daily lives may be less likely to fall ill and require an expensive medical intervention.
But what are the specific social determinants of health? Which examples are most common? And how can healthcare organizations and community partners act on these determinants?
Below, PatientEngagementHIT.com explores the most common social determinants of health and how the industry is beginning to tackle them.
Socioeconomic factors can encompass several different social determinants of health. Poverty can limit access to healthy food, safe neighborhoods, and good schools, among other things. Most prominently, poverty affects housing.
Although individuals can lose reliable housing for a number of reasons – trauma, violence, mental illness, addiction, or another chronic health issue – poverty remains a notable factor driving homelessness.
Hospitals treating a large homeless patient population can forge partnerships with housing departments to help drive housing in the community. Housing development partners can help place individuals who are homeless in houses and offer support that will help individuals maintain that housing.
“Access to safe, quality, affordable housing - and the supports necessary to maintain that housing - constitute one of the most basic and powerful social determinants of health,” wrote the Corporation for Supportive Housing (CSH) in a 2014 white paper.
“Supportive Housing, an evidence-based practice that combines permanent affordable housing with comprehensive and flexible support services, is increasingly recognized as a cost-effective health intervention for homeless and other extremely vulnerable populations,” CSH wrote.
Expanding housing development can also help ensure that living conditions are safe, free of asbestos, lead paint, or other environmental factors that can impair health.
Housing support can also account for other poverty-driven determinants of health, CSH said.
“Furthermore, supportive housing developments often attract or directly bring critical services to resource-barren neighborhoods,” wrote CSH. “Many supportive housing developments are increasingly featuring on-site or direct linkages to gym facilities, after-school programs, recreational spaces, food pantries, recovery support groups and full-service health clinics that benefit the larger community.”
Social supports and public good
There are countless different social support and public service gaps that are significant social determinants of health, according to Healthy People 2020, a public health organization developed as a part of the Affordable Care Act.
Issues such as race disparities, lack of social support groups, weak culture of health equity, and limited public services are all drivers of adverse health events.
Populations rely on community partners that will advocate for health equity. Examples of partners include the housing department working with homeless patients or health navigators helping a population’s surplus of single mothers.
Social support also includes efforts toward desegregation, which in turn may ensure certain races are not targeted disproportionately for the social determinants of health. One example is black patients living in poverty-ridden areas at a higher rate than their white patient counterparts.
Support for the public good means ensuring public services meet all patient needs. For instance, neighborhoods that are filled with trash need more support from public sanitation departments.
Public safety is also integral and requires the partnership of safety officers, such as fire departments and police. Police specifically can work to reduce drug issues, crime, and incidents of violence. Public safety officers can also help funnel patients out of negative lifestyles by reducing safety issues.
Geography can be a significant hindrance to healthcare access, especially for individuals living in rural areas with sparse facility options. These patients can have a difficult time getting to the hospital or the doctor’s office because they live far away from the care sites.
Some healthcare organizations are using telehealth to fill this care gap, but access to reliable broadband is currently making even digital healthcare consultations cumbersome. Earlier this year, the AHA and the American Medical Informatics Association (AMIA) called on the FCC to consider broadband and digital health access a social determinant of health.
“Race, ethnic, and age disparities in patient portal use and readiness and preferences for using digital communication for health-related purposes have shown to be significant, and this, in turn, reduces their ability to participate in many new and exciting mHealth solutions,” wrote AMIA President and CEO Douglas B. Fridsma, MD, PhD, FACP, FACMI. “These groups would benefit from an environment that would foster a low-cost broadband option with access that would be open and as ubiquitous as possible.”
Other organizations are leveraging community health partnerships to drive access to care in rural areas. In Nebraska, McCook Clinic PC and McCook’s fire department partnered to craft a reverse 911 program, according to a report from Bryan Health.
This program dispatched paramedics and EMTs to conduct follow-up care for senior patients or patients with limited transportation to follow-up care. Those dispatched also conducted home walk throughs to ensure the environment was safe for recovery.
Educational attainment, school intervention
Numerous studies have confirmed that higher levels of educational attainment can correlate with better health. Patients who have undergone more schooling may have more agency, and therefore be able to advocate for themselves in the healthcare system and better engage with their providers. These individuals may have also have undergone more public health education during their time in school.
Driving access to better housing and creating more connected communities is an important strategy for driving access to better schooling. Hospitals can also conduct community health needs assessments to identify gaps in health within a school-age population and partner with schools to improve upon those gaps.
Fillmore Community Hospital partnered with the Fillmore public school district to act on a community health needs assessment. This assessment revealed that school-aged children were struggling with mental and behavioral health care gaps, according to a separate Bryan Health report.
“They launched a pilot program integrating behavioral health in the school setting at the start of the next school year,” the document explained.
That pilot program included bringing mental health professionals to educate patients about mental and behavioral health and destigmatizing therapy and behavioral health interventions.
“Students in the program began demonstrating healthier social skills and increased willingness to proactively manage behavioral issues,” the report noted.
The list of social determinants of health is likely to continue growing. While not a new concept, healthcare organizations are just beginning to tap into resources to care for the social determinants of health as a part of their value-based and patient-centered care initiatives.
Healthcare organizations must keep assessing populations for the social determinants of health and discover new opportunities to partner with community groups to help care for patient needs outside of medical intervention.