Keeping populations healthy: How health systems can address social determinants


Elizabeth Hanes, RN, BSN

Essential Insights contributor, healthcare writer

U.S. Surgeon General Vivek Murthy stressed that health systems should re-envision healthcare as a service that not only treats the sick, but also helps people stay well when he spoke at the Root Cause Coalition's inaugural National Summit on the Social Determinants of Health.

"We are at the leading edge to transform healthcare in our country," Murthy said last December, as reported by Becker’s Hospital Review. "But we won't fulfill our potential if we are only pouring our money into the healing aspect of healthcare. We must move upstream and fully address the factors that drive health."

For centuries, medicine has been devoted to healing the sick. The U.S. healthcare model was built on this premise and for decades operated as a fee-for-service system. That paradigm is changing and reimbursement models that prioritize prevention and wellness are taking root. Health systems are now being rewarded for the quality of care and value they create under new reimbursement models.

How can health systems accomplish this shift toward advancing wellness among the populations they serve? One key is to identify and address the underlying social determinants of health, like the personal, social, economic, and environmental factors that could lead to health disparities.

Viewing social determinants as a root cause of illness

Clinicians may lament a lack of patient compliance with a treatment plan, such as reducing sodium intake to avoid heart failure. But they also need to dig deeper into the root causes of that patient’s non-compliance.

For example, a patient who has been advised to reduce her sodium intake may rely on salt-heavy fast food as her main source of nutrition if she can’t afford fresh, high-quality food naturally low in sodium. Or the patient may also live in a "food desert," where such foods are not available. So patient compliance often is dependent on many other factors.

"If the level of social understanding about a particular patient is 'does she have insurance,' then that's a 'miss' in terms of getting to the bottom of a person's social determinants of health," says Peter Mallow, a health economist at Cardinal Health. "Organizations need to dive deeply into all the socioeconomic factors of their patient population and then act on that data in order to achieve good population health outcomes."

Using data as a drill

Root Cause Coalition

A non-profit organization dedicated to addressing the root causes of health disparities.

One key way health systems can drill down into the social determinants of the populations they serve is to leverage existing analytics. Since the advent of electronic health records, health systems have been able to amass a great deal of data about health outcomes that can be connected to additional community research. In fact, the rising availability of geo-targeted health data could make it simpler to paint a picture of neighborhood health in a similar way to targeted consumer marketing.

"We are really in the nascency of this area, geospatial analysis, when it comes to health," said Michael Topmiller, a health geographic information systems (GIS) research specialist at Health Landscape, an innovation of the American Academy of Family Physicians. "We can identify which neighborhoods contain hiking and biking trails, for example, but we can't yet determine if access to hiking trails matters more to health than, say, unemployment. We are working on making those connections, but they're not quite there yet."

Even without knowing precisely which social determinants may have more of an impact on health than others, health systems can begin working with the data they have to mitigate the potential health impacts of various social determinants. For example, patients in certain areas may not have access to specific medical supplies, like glucose monitoring devices, due to a lack of drug stores nearby. So it may be best for a healthcare provider to have supplies shipped straight to the patient’s home. Tactics like this could help avoid unnecessary hospitalizations.

"Consumer analytics tackled this problem years ago," Mallow said. "Just as targeted marketing uses aggregated data that includes your neighborhood demographics, income levels, locations of retail stores in proximity to your address, so to can health systems use data to get a picture of the social determinants of their populations to better inform patient care."


Partnering with non-healthcare entities to improve population health

In his December remarks, Murthy pointed out that many institutions not typically considered to be healthcare-related still affect population health. He pointed to housing, urban development and educational institutions as examples of organizations whose policies have direct impacts on health.

Experts agree that health systems can improve population health by tapping the expertise of these types of non-healthcare agencies and institutions and bringing it to their patients.

“One of the best ways that health systems can address social determinants in their populations is by connecting people to other systems that already exist," said Jennifer Chubinski, vice president of innovation and learning at Interact for Health, a health advocacy organization in Cincinnati. “For example, one health system hosted legal aid staff inside their children's clinics. This allowed families who needed some sort of legal assistance—to help with food stamp issues, for instance—while they were already in the clinic."

Why addressing social determinants benefits healthcare providers

Beyond fostering community goodwill, addressing the social determinants of health can help better position providers for new reimbursements models and avoiding penalties, such as the readmission penalty for heart failure. Under the accountable care model, taking steps to help patients comply with treatment plans brings a financial benefit, in addition to many social benefits.

Addressing social determinants in health can help us change our model of healthcare from merely treating the sick to one that helps people stay well.