People who are in poor health or use more health care services are more likely to report multiple unmet social needs, such as food insecurity, unsafe neighborhoods, lack of good housing, social isolation, and poor transportation access, found through a survey conducted by McKinsey. The results are summarized in Addressing the Social Determinants of Health.
The growing recognition of the influence of social determinants reached a tipping point last week with the news that Kaiser-Permanente would work with Unite US to scale services to people who need them.
The mainstreaming of SDoH speaks to the awareness that health is made where we live, work, play, pray, learn and shop….beyond the health”care” system of hospitals, doctors’ offices, and prescription drug dispensaries.
McKinsey conducted the survey among over 12,500 U.S. adults between 18 and 64 years of age in December 2018. Respondents were both uninsured and insured through individual coverage, Medicare, Medicaid, and dual enrollees. For the individual and uninsured populations, respondents were limited to people at 250% of the Federal poverty level or below.
The second graphic illustrates that people reporting poor health — physical and mental — are at higher-risk of facing multiple unmet needs, like those listed in the first chart (food, safety, housing, social support, and transportation). Over one-half of folks interviewed in the study were adversely impacted by at least one of these five social determinants of health (SDoH).
Note the third data point in the second chart — self-reported high healthcare utilization. Unmet social needs double one’s risk of needing more healthcare services, with 45% of people with higher intensity healthcare use reporting multiple unmet needs compared with 21% of those using more healthcare.
McKinsey also found that consumers reporting greater use of the emergency department and inpatient hospital admissions were also more likely to report unmet social needs.
Food insecurity was the most important SDoH for driving IP and ER use, followed by safety risks, housing challenges, transportation and social isolation.
People at-risk for SDoHs would welcome receiving services from their health insurers: 50% would use discounts at grocery stores to support their purchase of healthy foods, 48% would like gym memberships, 45% a wellness dollar account (like an HSA or MSA), 41% financial support for home improvements to address health concerns (think: clean water, mold abatement, safe flooring to prevent falls), and 40% would like to access a (free or low-cost) drop-in clinic on evenings or weekends.
Health Populi’s Hot Points: The growing retail health ecosystem from the barbershop and beauty parlor to shopping centers, new-fangled pharmacies, and grocery stores underpin the platform for health/care touchpoints that can deliver on the social determinants. To further bolster SDoHs that address health equity, public policies can and must also be baked with health, from transportation to food systems and education.
“The new Thrive Local network will start rolling out summer 2019,” K-P’s press release said. “Within three years, it will be available to all of Kaiser Permanente’s 12.3 million members and the 68 million people in the communities Kaiser Permanente serves…. within a robust network of nonprofit, public, and private resources….This is one of our bold moves,” CEO Bernard Tyson is quoted.
K-P found that up to 29% of plan members with the greatest medical problems deal with food insecurity; 23% are concerned about housing stability.
In my book, HealthConsuming: From Health Consumer to Health Citizen, I discuss “Zip Codes, Genetic Codes, Food and Health” in Chapter 7. The social determinants through “place,” our personal geography, have a greater impact on our overall health, well-being, and productivity than our genetic endowment at birth.
In the chapter, I introduce this concept through the original work of Dr. Tony Iton, who worked in public health in Alameda County, California, in the 1980s and connected the dots between the SDoH and the health issues facing his community. Alameda County is part of K-P’s target market.
K-P’s bold move will benefit folks both within the health plan’s membership along with their neighbors’ health. That’s bold, for sure, but also smart: health is social, K-P knows, as our individual choices bolster (or diminish) our neighbors’ beyond our individual well-being.