Five denominations of social determinants shaping population

Five denominations of social determinants shaping population

Breaking down the social determinants of health (SDH) into their component parts can help providers in assessing their community challenges and help in implementing targeted initiatives. These initiatives help in improving the health and wellbeing of patients experiencing socioeconomic disadvantages.

The World Health Organization(WHO) defines social determinants as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Economic and social policies, political systems, and social norms all contribute to creating an environment in which individuals thrive or experience challenges. As per WHO, healthcare providers face a set of complex and deeply personalized set of restrictions and opportunities for each patient.

The Five Denominations of Social Determinants can be grouped as follows:

  1. Economic Instability: Some key economic instability factors include poverty, employment, food security, and housing stability
  2. Education: A few of the education determinants include high school graduation, enrollment in higher education, language and literacy, early childhood education and development
  3. Social and Community Context: Some of the social and community context determinants are social cohesion, civic participation, discrimination, and incarceration
  4. Health and Health Care: Some of the healthcare determinants are access to health care, access to primary care, and health literacy
  5. Neighborhood and Built Environment: Various environmental determinants are access to healthy foods, quality of housing, crime and violence, environmental conditions

Many of these areas are inter-related and have a compounding effect on the health and welfare of the patient. Poverty has a greater influence on health, and impacts access to better care & the ability to pay for medications, afford healthy food and healthy life style choices. Poor housing facilities poses dangers to many infestations. Poor environmental conditions, for example, bad road conditions in neighborhood, will also affect the health and welfare of patients.

Poor housing facilities can pose dangers such as exposure to many infestations. Education has a huge impact on patients and helps in gaining health knowledge. Social network can have positive effects on people, but many a times can also be harmful. Social networks can reinforce unhealthy behavior such as smoking and drinking. So, if a person tends to be on all of these barriers, access to care then comes into question. In these scenarios, medical care has less of an impact on health, than social determinants.

In a nutshell, the social determinants of health have a major accountability in an individual’s ability to understand the importance of healthcare.

Why do we need to focus on Social Determinants?

A value-focused organization in Minnesota began enrolling patients in its Social Determinants program. The aim of the program is to increase preventive care and to reduce preventable hospital admissions, and emergency department (ED) visits for vulnerable patients. The organization used various care coordination models to meet patients’ physical, behavioral, social, and economic needs. Within one year of the implementation of the program, ED visits were decreased by 9.1% and outpatient visits increased by 3.3%. There are many such examples, where incorporating social determinants as part of the care delivery models have a positive and longer-term effect on the patient care outcomes.

How can clinicians use social determinants to improve patient outcomes?

For example, two patients (A & B) get diagnosed with congestive heart failure. Say for example, Patient A is married with kids, has good family support and community support and is financially secure. The likelihood of him complying with the treatment plan, the medication, regular visits and undergoing potential procedures is higher. If Patient B is homeless, and does not have proper transportation to the clinic or is dependent on food stamps, there is a higher likelihood of him not adhering to the treatment plan.

For such patients, their immediate needs of food, clothing, shelter and financial difficulties need to be dealt with first, before we address their medical needs or expect care adherence from them. By including social determinants in the care delivery process, the healthcare can be tailored for each patient.

Their original treatment plans might be identical; they might be getting the same medications and procedures, but Patient B needs some more additional help or support to take care of themselves. Providing this extra support will go a long way into better patient care outcomes for value-based care organizations.

Social determinants as a part of Population Health Management

How to use population data in your daily work to identify barriers and create a unique program to address social concerns? Many provider organizations are re-defining their care delivery models into a unique model called ‘The Circle of Care’. The circle of care model includes not only services and programs around physical health but also behavioral, cultural, environmental aspects and other barriers to health and wellbeing. Some of the health and wellbeing barriers include linguistic and cultural barriers, lack of health literacy, misunderstanding of health coverage programs, lack of transportation, managed care default, and uninsured or underinsured.

How do we approach these, what do we do?

A unique approach is to leverage the social determinants of health such as providing quality healthcare, education to improve the overall well-being of a family, bringing underserved ethnically diverse community into the main streams of society, through care and effect, in a competent manner respecting the dignity of patients.

A circle of care model that puts social determinants of health directly into the daily way of working. These social determinants have to be a part of different services of outreach, social services and integrated social determinants of health efforts enabling all the services for patients. For the program to be effective, social determinants to be made main stream in a care center delivery model, and every staff involved right from front desk executive to physicians, should work as a team in assessing patient needs and guiding the patient to treatment, education, training and self-sufficiency.

CMS Addresses Social Determinants of Health:

Centers for Medicare & Medicaid Services(CMS) has initiated the Accountable Health Communities (AHC) Model to explicitly address the social determinants of health as an important factor in achieving better health outcomes. AHC recognizes that social factors outside the purview of the traditional healthcare often encounter significant health impact outcomes, affecting the quality of medical care provided.

The AHC model is based on emerging evidence that addresses health-related social needs while improving health outcomes and reducing costs. Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, such as reducing an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.

AHC will initially target the following core areas:

  1. Housing instability and quality
  2. Food insecurity
  3. Utility needs
  4. Interpersonal violence
  5. Transportation needs

CMS’s recent action reflects an emerging trend for healthcare providers and insurers to address social issues such as housing and food security, previously considered beyond the scope of healthcare. Yet evidences demonstrate that addressing basic social needs in conjunction with improved access to medical care increases overall health outcomes and reduces cost.

The AHC program will award 44 cooperative agreements from $1 million up to $4.5 million, depending on whether an organization is classified as Track 1 (Awareness), Track 2 (Assistance), or Track 3 (Alignment).

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