As a doctor, it is pretty humbling to reflect on the fairly minimal impact our health care system has on individuals’ overall health. One study I find particularly intriguing shows that socioeconomic factors (e.g., education and income), and physical environment (e.g., security and safety at home and reliable access to transportation), affect a person’s health outcomes just as much as their behaviors (e.g., mental health, diet, and physical activity) and the clinical care they receive. The data indicates an even, 50/50 split.
I suspect that many people view such data as interesting—but not exactly surprising. We have always known that sometimes there is little we can do medically to help a person until we have attended to their so-called social determinants of health (SDOH). Concerns about money, transportation, food security, housing uncertainty, and other socioeconomic factors nearly always prevent people from concentrating on their health.
That is not to suggest we should throw in the towel, of course. On the contrary: I see it as a clear call to action. The time for ruminating about SDOH is behind us; it is time to roll up our sleeves and finally address it.
If I am preaching to the choir, great! The question is, where do we start?
Tackling SDOH is difficult, obviously. If it were not, we would have done it ages ago. But I have already seen individuals and organizations make an impact by teaming up with partners in their communities. In fact, I would argue that communities must work together to mitigate SDOH. That is the whole point; health care does not exist in a bubble.
Most of the SDOH successes I have seen start when physician groups, hospitals, and health systems join forces with community-based organizations (CBOs) such as food banks, drug treatment centers, and shelters. I absolutely love the idea of CBOs and health care providers working hand-in-hand to care for the people in their communities. Unfortunately, however, that rosy picture quickly dissolves under the hard reality that it takes shared data to succeed.
One of the best ways to match people with the right resources is for health care providers and CBOs to join forces in ways they have not before. While some CBOs are both funded enough and sophisticated enough to team up, a significant number of the nonprofits I am aware of still rely on Excel spreadsheets, or even paper, to organize and share the data needed for this level of collaboration.
To that end, I believe the U.S. health care system and public health policy should support access to data management software for all nonprofit organizations that are helping people in need. That way, they can make the best use of their information—including linking with health care entities, while complying with HIPAA and other relevant federal and state privacy laws, to alleviate some of our most critical SDOH problems. Why not start a grassroots effort to propose a national policy? Do not get me wrong: I am not usually a “big government” guy, and I recognize that such an effort would require national consensus and support. But advancing health equity and solving for SDOH will require us to do three things:
- Improve our ability to identify and prioritize people whose health and wellbeing could be impacted by SDOH.
- Empower collaborative, strategic community partnerships that provide people with the resources they need for better health.
- Influence policies and regulations to advance the ability of health care providers and communities to address SDOH.
SDOH is a multifaceted challenge, which means there are plenty of ways for each of us to play a role in the solution. We can each do what we can as individuals, and then lean into community organizations for their assistance. For example, as individual health care providers and community leaders, what is really stopping us from working with public transportation and ride-sharing programs to ensure that people without their own vehicles can get to regular health care checkups?
From one human to another, we can all be present and do something. We do not need grandiose schemes or perfect solutions all at once. Let us not be afraid to start small.
During the COVID-19 pandemic, for instance, one provider organization began calling some of its vulnerable patients to see how they were doing. They called it a “wellness check-in.” They learned about patients’ struggles through simple phone conversations and connected hundreds of patients with needed resources.
Although many community SDOH programs currently rely on phone calls, we should also consider how we could use tools such as texting, instant messaging, or video conferencing to reach people in need. Technology like telehealth offers a way to reach people, yet the internet still needs to be built out to support remote solutions in much of the country. Time to advocate for more universal broadband coverage, perhaps?
We cannot overlook the fact that the COVID-19 pandemic has amplified long-standing disparities in our health care system. We cannot entirely fix some of the psychosocial and environmental factors that exist, either. But we can at least try to make a difference in the lives of the people we encounter. Let us finally start making a dent in SDOH in our own communities. It does not matter how you touch health care—as a clinician, payer, policymaker, patient—opportunities exist for you to help move the proverbial needle on SDOH.
Joe Nicholson is a health care executive.
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