Social Determinants May Be an Easier Nut to Crack

Modern medicine has become increasingly preoccupied with the prospect of a future where we grow organs in petri dishes and consider genetic modifications to prevent and treat disease. These are exciting innovations, and there may be a legitimate future in them.

But do these address our greatest health challenges as a society? And are we taking advantage of the more basic potential solutions available today?

Some of America’s most significant health issues might be better controlled with educational and policy changes than with scientific innovation. Today, we face many questions: Why are African-American men more likely to be diagnosed with aggressive prostate cancer than men of other racial and ethnic groups? Why are wealthier people healthier and living longer? Why are people living in rural areas more likely to report health problems than urban residents?

Studies of these social determinants of health (often referenced as “SDOH”) are not new. But there is a growing body of research that offers similar insights: Disparities in health outcomes are attributed to identifiable and potentially influenceable social determinants.

SDOH are the “conditions in which people are born, grow, live, work and age,” according to the World Health Organization. They can include political, socioeconomic and cultural factors like race, income and education level. They also include neighborhood, housing stability and access to nutritious food. Together, they can provide a holistic picture of who an individual is and what can affect his/her health.

However, we need to translate these findings into programs or policies that consider SDOH in delivery of care and prevention. How can we address the problems and offer potential solutions?

The federal government’s interest in social determinants appears to be on the rise. Adam Boehler, director for the Center for Medicare and Medicaid Innovation, and Department of Health and Human Services Secretary Alex Azar have each stated that they would like to see more demonstrations that test the integration of SDOH in the delivery of health care. They have said this will be an interagency effort including the Treasury Department and Housing and Urban Development.

Existing initiatives include CMMI’s “Model One,” which allows a single care-providing entity to pay for an individual’s broader needs like cost of transportation and nutrition. And Medicare Advantage plans are allowed to cover supplemental benefits starting this year. Some MA plan participants may have coverage for Uber/Lyft rides to physician appointments and air-conditioning units if they’re asthmatics. A goal of these programs is to remove or reduce the social and economic barriers to people managing their health or pursuing the services they need.

Several private initiatives also take aim at improving health outcomes by addressing SDOH factors.

For example, Geisinger Health System, a health care system in Pennsylvania, operates Fresh Food Farmacy. This is a program that provides fresh, healthy food and education to qualifying diabetic patients. The Farmacy recognizes that a healthy diet and exercise can be just as important as medication in regulating blood sugar and preventing long-term complications. The “food as medicine” approach aims to help people to manage their conditions through behavior and lifestyle changes.

Taking a different approach, Kaiser Permanente is investing in housing for at-risk groups in order to reduce homelessness and housing insecurity, which are two SDOH the health system recognizes are issues in some service areas. Kaiser Permanente’s plan is to invest $200 million to purchase and upgrade an apartment complex in Oakland, Calif., and to create and preserve multifamily rental homes.

Hospitals are also looking to address housing: Nationwide Children’s Hospital in Columbus, Ohio, and the Boston Medical Center have similar efforts to improve housing conditions and fight evictions in affordable housing.  

These programs form a great start. But to truly address the problems our country faces with SDOH — both in their impact to quality of life and to America’s health care cost burden — we need the federal government to support long-term solutions.

It starts with recognizing that SDOH are real and that we need to start tackling them. For that, the administration and private sector deserve credit for taking this on.


Ipsita Smolinski is managing director of Capitol Street, where she advises clients on national health care policy and emerging trends.

Heidi Chang is a fellow at McAllister & Quinn, focuses on health policy and has a background in biochemical engineering from Brown University.

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