Understanding the social determinants of health and how they impact population health October 29, 2018
A patient’s health status can be impacted by many factors, including genetics, eating habits, and physical activity (or lack thereof). There are a number of other factors that can affect a patient’s health as well, which cannot necessarily be treated with medications or traditional care plans. Social determinants of health are, according to the World Health Organization (WHO), “the conditions in which people are born, grow, live, work and age.”
For patients, social determinants of health, “circumstances (that) are shaped by the distribution of money, power and resources,” can influence their food choices and even whether they have access to quality healthcare. Social determinants include “intangible factors such as political, socioeconomic, and cultural constructs, as well as place-based conditions including accessible healthcare and education systems, safe environmental conditions, well-designed neighborhoods, and availability of healthful food.”
For healthcare providers, social determinants of health affect decisions made for population health management. The physician must take into consideration whether patients can afford to eat healthy foods, fill their prescriptions, and follow other plans of care that may be out of their range either financially or logistically. True value-based care can involve collaborating with community organizations and social service agencies to gauge needs and provide appropriate care based on the patient population’s circumstances.
The “complex interactions and feedback loops” of social determinants of health, as described in a recent article in NEJM Catalyst, include “poor health or lack of education (that) can impact employment opportunities which in turn constrain income. Low income reduces access to healthcare and nutritious food and increases hardship. Hardship causes stress which in turn promotes unhealthy coping mechanisms such as substance abuse and overeating of unhealthy foods.”
Value-based care for these populations will depend on the physician understanding the social determinants of health for the patient group, including the economic environment, employment opportunities, access to safe drinking water, and availability of quality food choices. Maintaining detailed patient data in electronic health records (EHRs) can help the physician track and manage the population health of patients who are impacted by these social determinants of health.
Healthcare professionals have available significant “data and research which indicates that the social determinants of health have a higher impact on population health than healthcare and that a higher ratio of social service spending versus healthcare spending results in improved population health.”