Enlightened health/care industry and public policy stakeholders have begun to embrace and address social determinants of health. These are the inputs that bolster health beyond health care services: they include economic stability like job security and income level (and equity), education, and access to healthy food, food security, safe neighborhoods, social support, clean environments (water and air), and in my own update on SDoH factors, access to broadband connectivity.
As physician leaders in the AMA, technology advocates from AMIA, and numerous health plans focus efforts on strengthening social determinants, what do people – consumers, patients, caregivers — think about these factors that help make their health beyond their personal physicians, hospitals, and prescription drugs? Bridging Gaps to Build Healthy Communities, a study from the Anthem Public Policy Institute, responds to this question. The data to inform the answer was aggregated from social networks, patient forums, news sources and research papers and analyzed by Quid, a data analytics firm.
Quid quantified the “public narrative” of SDoH, shown in the right circle in the first chart, finding that education was the most-cited factor among industry and organizations talking online about the topic. Following education, economic stability, healthcare services, neighborhoods and social supports garnered the most mentions.
How everyday people view SDoH factors is entirely different: healthcare ranks high above the other issues, followed by social supports and then food. Lowest ranked is education, which was #1 in the public narrative.
Next, Anthem and Quid mined the SDoH factors by health condition looking at patients’ mentions of topics in cancer, diabetes and mental health discussion forums.
Among the SDoH factors, healthcare services ranked uniformly highest across all conditions, the second bar chart shows. But then there are variations in SDoH perceptions by condition: for mental health, social support and economic stability rate most potent. For cancer, social support, economics and neighborhood are key. And, for diabetes, it’s food, then social support, that rate most frequently mentioned.
Underneath the specific condition mentions are inter-relationships between SDoH factors. The networking-overlaps of these are illustrated by the third graphic copied from the report on SDoH mentions in diabetes social networks. While food is the most-mentioned factor, it connects to neighborhood in terms of an individual’s access to healthy, well-priced nutrition options; to economic stability, relative to a person’s ability to pay for good food; to social support, for friends and family who positively influence and laud a person’s food choices (or take the opposite approach); and a healthcare system that promotes healthy eating and sound, engaging nutrition education.
Anthem’s report goes into depth on the impactful roles of education and strong social support systems for health. Social support bolsters outcomes for cancer, diabetes and mental health alike. Anthem found that people dealing with mental health conditions were less likely to be receiving the social support they needed, which then led to feelings of insecurity and self-doubt, the researchers recognized. This was true, too, for caregivers and family members concerned about taking time off from work and lack of support for their own caregiving time and stress.
Speaking of work, people with mental health conditions are also disproportionately concerned about economic security — with finding and retaining a job, the stigma associated with mental health if disclosed to an employer, and ultimate (negative) impact on income and financial health.
Health Populi’s Hot Points: The last graphic comes from my book, HealthConsuming: From Health Consumer to Health Citizen, taken out of the chapter on “Zip Codes, Genetic Codes, Food and Health.”
Given the inter-connected nature of social determinants, they should be everyone’s concern across the health/care ecosystem. The current health reform discussions focus on healthcare services, which is but one of many factors that makes health for individuals and communities. Appreciating and leveraging local networks of social determinants would bolster health beyond healthcare, as the third diagram for diabetes demonstrates.
Our inter-connections as people, for the SDoH of social support, cannot be over-stated. Our connected-ness, as Christakis and others have pointed out, can bolster our health….or diminish it. You can read more on this critical factor in HealthConsuming, from the ancient Greek Hippocrates to the modern Greek, Christakis. Health is social, and it’s contagious. Beyond making it for our selves, we model it for others, as well.
Postscript later on 29th May: After I posted this story, I learned that Cerner just launched a Social Determinants of Health Collaborative. The health IT company will work with health providers and other stakeholders to address SDoH like food and transportation needs, incorporating screening tools into the firm’s electronic health records system. Providers identified in the news story included Truman Medical Centers (in Cerner’s HQ town), Los Angeles County Department of Health Services and Marshall University School of Medicine in Huntington, WV.