updated July 2018
Quantifying the Impact of the Social Determinants of Health
At the US News Healthcare of Tomorrow Conference on Nov. 2, Dr. Pedro J. Greer told conference attendees “between 80 and 90 percent of diseases are caused by non-biological factors.” He explained “the number one cause of transplants for patients under the age of 50 is fatty liver, and the number one cause of fatty liver is obesity.”
This is by no means news.
Zip Code Matters
There are lower rates of obesity and diet related diseases in census tracts with access to healthy and affordable foods, safe recreational spaces, reliable and affordable transportation, and affordable childcare — the list goes on. Moreover, the built environment, location familiarity, and perceptions of safety are highly correlated with dietary habits and population health (outcomes).
Again, these facts are by no means news. In fact, they are well documented across disciplines.Between 80 and 90 percent of diseases are caused by non-biological factors. These factors are referred to as SOCIAL DETERMINANTS OF HEALTH. Click To Tweet
SOCIAL DETERMINANTS OF HEALTH
The Office of Disease Prevention and Health Promotion (ODPHP) refers to Social Determinants of Health (SDOH) as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
HEALTH POLICY vs. PUBLIC HEALTH
Prior to consulting for ISPE, I:
- Worked as a public policy and government affairs analyst for a Fortune 500 health insurer;
- Worked in local government as a community policy analyst for an Affordable Care Act (ACA) funded, multi-sector healthy food access (SDOH) initiative;
- Worked as a public health and outreach professional for five years prior to attending graduate school. Cumulatively, I have provided community based services and supports to > 7,000 Hillsborough County (FL) residents in home and community based settings; and
- Studied Food Systems Policy and Planning in graduate school. I have since given presentations on the topic in academic settings.
The disconnect between health policy and public health is concerning, yet not surprising. Politics direct health policy. Evidence-based interventions direct public health (initiatives).
I’m glad certain policy and health care circles have finally caught on to the fact that there is a link between the built environment and health outcomes. Notwithstanding, I find it unacceptable it has taken this long.
Better Late Than Never
Unfortunately, these discussions entail health policy experts enumerating the ways in which they struggle to define SDOH indicators, collect and analyze standardized SDOH data, understand geographical components of SDOH, and incorporate SDOH indicators in capitation rate development and value-based payment arrangements.
1. SDOH indicators and data collection standards already exist.
As a best practice, a prerequisite to taking on a new endeavor should be the completion of a thorough benchmarking and best practices study.
2. The use of GIS software remains severely underutilized in Medicaid and other health policy circles.
As a best practice, when hardships identifying geospatial components of a problem arise, utilize geospatial technology. Having used GIS to map various SDOH data points, I struggle to understand why this is — seemingly — such a challenge.
Notably, GIS is useful for health insurers required to meet network adequacy standards enumerated in CMS’ Medicaid managed care final rule. GIS is also an effective business development tool.
3. Innovation, a term health policy experts often use, requires new ideas and methods.
To that end, the following organizations (and their affiliates) should have a seat at the table during future SDOH discussions:
- The American Planning Association;
- The International City/County Management Association; and
- The National Association of Counties.
Each association has experience with SDOH initiatives and can offer valuable insights.
Through sweeping authority to direct zoning and other land use policies, local government actions profoundly inform the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Finally, social workers and case managers — not program directors, the people on the ground — need a seat at the table if the goal is to meaningfully address SDOH.