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The Social Determinants of Health: What Are They, and Why Should We Care?

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The World Health Organization defines social determinants of health (SDOH) as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Some examples of social determinants of health include: income and working life conditions, access to affordable and quality health care, social protection, environment (like air quality), access to housing, food and education, social inclusion and non-discrimination [1].

With all of the burdens the health care system already has to shoulder, adding the SDOH may seem unnecessary. One might think, “there are already so many social and charitable organizations to handle this stuff. Why should it be an issue for health care?” However, there is increasing evidence to show that concern for the collection and analysis of SDOH data will benefit both health care systems and the communities that they serve. According to the WHO, “research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH account for between 30-55% of health outcomes” [1]. In addition, Sanne Magnan MD, PhD in her 2017 research article Social Determinants of Health 101 for Health Care: Five plus Five, shows how investing in improvements to SDOH can lead to better health outcomes and decreased health care costs. There was a recent review of peer-reviewed literature analyzing 39 studies, mostly done in the U.S. and regarding low-income populations. These studies concerned investments in social services or integrated models of health care and social services. The interventions with the most positive health outcomes were respectively housing support, nutritional support, income support, care coordination and community outreach. Of all the studies reviewed, 20 showed improved health outcomes, 5 showed decreased costs, and 7 showed both. The remaining results were mixed, nonsignificant, or negative (p. 5). Furthermore, federal entities such as Medicare and Medicaid as well as private insurance companies are increasingly shaping their payment models to reward improvements in social and health care outcomes, rather than process measures of whether a specific activity has been completed (think: rewarding a decrease in the number of community members who smoke, rather than just the provision of anti-tobacco education before hospital discharge) [2].

So what’s the easiest way for health care providers to get involved? Routine and updated collection of SDOH data, particularly from community health centers. “Health centers serve more than 28 million patients, 58% of whom are members of racial and ethnic minority groups and 68% of whom are at or below the federal poverty level” [3]. Based on these numbers, CHCs appear to be uniquely positioned to successfully collect SDOH data from the most vulnerable community populations. Then, through partnerships with other local organizations, this data can be interpreted and those in need can actually receive the necessary social services for their situation.

Although we recognize the importance of accurate and updated SDOH data collection, being involved with SDOH improvement as a field clinician directly working with patients is a daunting task. Clinicians (doctors, nurses, therapists, assistants, etc.) already have so many responsibilities on their plates, and adding worries about SDOH and documentation of these measures can easily lead to burnout and frustration. Curago can help to alleviate some of this pressure. An easy way for clinicians to be involved with improving social determinants of health is by thorough and routine data collection. Curago’s software automates SDOH data collection by having patients answer questions during pre-registration and check-in. It also tracks how often questions are asked of patients automatically so patients are more likely to respond appropriately. The automation of this data-collection process helps to avoid clinician burnout while increasing the chances that patients actually answer the questions on a routine basis.

 

[1] World Health Organization. (n.d.). Social Determinants of Health. World Health Organization. Retrieved April 14, 2022, from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 

[2] Magnan, S. 2017. Social Determinants of Health 101 for Health Care: Five Plus Five. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201710c

[3] Margaret Cole, M. B. A., Mimi Jolliffe, M. P. H., Cynthia So-Armah, M. D., & Barbara Gottlieb, M. D. (2022, January 1). Power and participation: How community health centers address the determinants of the social determinants of health. NEJM Catalyst Innovations in Care Delivery. Retrieved April 14, 2022, from https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0303 DOI:https://doi.org/10.1056/CAT.21.0303