We Need to Do a Better Job Addressing the Factors that Cause Poor Health

There is no question that the United States has the most advanced health care in the world.  From the quality of our medical professionals to the continuing development of cutting-edge technologies, treatments and diagnostic tools, we have an unparalleled capability to combat illness. 

And yet, it is widely acknowledged that our health outcomes are not as optimal as we would expect or wish them to be, and it can’t go unnoticed that life expectancy in the United States has dropped in two of the last three years.

To improve the health of Americans, we believe it is imperative that policymakers, community leaders and all of us who play a role in health care delivery and payment take a more expansive, holistic view of what it takes to improve an individual’s well-being. We need to look well beyond the physical walls of hospitals and clinics and acknowledge that there are social and environmental factors affecting health. And while this idea is not new, the need to address these challenges boldly and systemically is more compelling than ever.

Research tells us that access to and quality of clinical care only accounts for 20 percent of the factors that affect our health. A far greater impact is found in the social determinants of health — the availability of nutritious food, accessible transportation, social support and connections, affordable housing, community-based services, exercise and the choices people make to engage in unhealthy behaviors, just to name a few.

To put it succinctly, our medical system devotes the lion’s share of its attention to treating the symptoms of illness, but we devote less attention to the factors that cause, or exacerbate, poor health. The linkage between social determinant gaps and declining health is undeniable.

Studies have found that social isolation and loneliness can cause health deterioration just as much as smoking cigarettes. Four million medical appointments are missed each year, often because patients lack the transportation to get to the doctor. Conversely, states providing higher levels of social services have reduced rates of obesity, cancer, type 2 diabetes, myocardial infarction and other illnesses.

The good news is progress is being made. Medicare Advantage, a program that’s enrolling nearly 1 in every 3 seniors, has adopted new rules that allow participating health plans to cover supplemental benefits like nutritional and dietary education and counseling services. A number of state Medicaid programs have received federal waivers to cover services that are not directly health-related, such as nutritious meals to seniors and people with disabilities or professional support for those dealing with domestic violence or toxic stress.

The private sector is stepping up, as well, working to improve the quality of care delivered to older Americans by examining the root cause of poor health conditions. That means looking at factors such as nutrition and diet, physical exercise, or how much engagement a person has with other people in his or her local community. Tivity Health offers older folks enrolled in some Medicare Advantage plans access to SilverSneakers, a fitness program that promotes physical activity and has been proven to reduce social isolation by facilitating social connections.

Aetna is working to provide more people enrolled in Medicare Advantage with supplemental food and transportation benefits. In addition, the company is currently piloting several innovative approaches to care coordination in collaboration with community-based organizations that have the trust of local residents and the ability to reach those with serious needs. For over 20 years, Aetna has also invested over $50 million annually in housing infrastructure around the United States.

But it’s not yet enough. On a systemic level, there is more that can and should be done. We aren’t utilizing available data to the full extent permitted by law, and we have not yet developed uniform payment structures, nor the right or standard evaluation tools to capture social service needs in a systematic way and understand how non-medical services could improve health care outcomes.

And then there is simply the matter of spending priorities. Other industrialized countries spend approximately $1.70 on addressing social determinants for every dollar spent on health care. We spend 56 cents on social determinants for each dollar devoted to health care services. And yet, life expectancy here is two years shorter than in those nations.

Recently, through the Healthcare Leadership Council, we brought together a range of stakeholder groups representing government, nonprofits, payers and providers that are committed to addressing social determinants of health. The energy is there. The ideas are plentiful. The early outcomes are encouraging. 

What we need now is the national resolve and a cohesive strategy that addresses all the factors affecting our health to improve the overall well-being of all Americans.


Donato J. Tramuto is chief executive officer of Tivity Health. Fran Soistman is executive vice president and head of government services for Aetna, a CVS Health business.

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