Guest Column | July 8, 2019

The Role Of Social Determinants In Influencing Population Health

By Derek Ross, Business Leader of Population Health Management, Philips

Population Health Management Preventative Measures

While we’re starting to see some recognition of the role that social determinants play in contributing toward health and wellbeing, the influence and impact of factors such as health behaviors, food supply, housing, financial situation, access to healthcare and social relationships on overall health have so far been greatly underestimated. We are complex and our health reflects this complexity. Including social determinants in health evaluations holds great promise not only for patients and broader population groups, but for healthcare providers and health systems overall.

When we look at both healthcare and social services spend globally, the United States spends a relatively ‘average sum’ when compared with its peer countries. Yet, this research from Yale University also tells us that early investment in population interventions or social determinants of health can lower healthcare spend, giving us all reason to take note. Social and economic factors are often the root causes of poor health conditions that practitioners are witness to in the medical practice. Not addressing the influencers that lie outside the healthcare institution or other clinical environment can have major implications for the long-term health of existing patients and wider populations. This is especially critical as we make the shift from reactive sick care to preventative healthcare that tackles health challenges from the very start of the journey.

Tapping Into Technology

In order to improve health outcomes and reduce costs, we need greater knowledge to better understand what the challenges are and where the opportunities for improvements lie. This is where healthcare practices can use technology to tap into data that gives us a better picture of how our patients live, and under what conditions, and what obstacles might be preventing them from living a healthy life or realizing better health outcomes.

Within our medical practices, Electronic Healthcare Records (EHR) are already collecting patient data digitally. This data enables practitioners to look at a patient’s immediate and past medical history. Encouragingly we are starting to see social determinants data of the patients at various touchpoints being collected. However, this data varies from customer-to-customer and from practice-to-practice. The biggest challenge now is how to make the data actionable, with the added complexity that no single person or organization has taken responsibility to collate or analyze it. Increasingly, we’re seeing recognition that a more uniform approach to collecting evidence-based data that encompasses social and economic factors can and will have a positive impact on health.

Working Together To Deliver Quality Care

Better understanding the specific social and economic factors that are influencing the health of a given population will mean that patients, healthcare providers and local communities can all benefit. By gathering and aggregating this data to identify patterns – whether this is for a specific chronic disease, such as lung cancer, or of a particular age group, such as 65+ – trends can be identified and as a result, healthcare professionals can better segment and treat these patients.

By understanding these factors impacting health, there is an opportunity for providers - from communities, schools, healthcare providers, policy makers and IT firms - to combine efforts and form long-term partnerships that help improve the health of the communities in which we live and work.

Connecting information from multiple sources will contribute toward building a more accurate picture of a patient and in turn provide a 360-view that can help inform a proactive healthcare plan, based on data-led learnings, and that puts the community population front of mind.

How Japan Is Understanding Social Determinants Of Health To Benefit Communities  

Understanding and learning from the social challenges that exist in other regions and communities around the world can help inform localized initiatives that positively impact physical and mental wellbeing for patient populations.

Challenge: Japan has an aging population challenge, with the highest percentage of elderly citizens than anywhere else around the world. For consumers aged 65+, emphasis on maintaining their wellbeing was being placed on daily exercise, regular check-ups and healthy eating.

Insight: A deeper look found that elderly Japanese consumers wanted more, specifically a sense of purpose – the opportunity to learn new skills, gain more responsibility and get active. 

Outcome: By better understanding the patient mindset, more targeted local community projects could be rolled out, giving the elderly more purpose-oriented goals and activities to work towards, as well as more targeted projects to get involved in. This had a positive effect on health and wellbeing, helping to keep more elderly out of clinical, acute care settings. In some sectors, companies in Japan are also equipping staff with robotics to assist as mechanical aids that take off the physical pressure associated with many jobs and ultimately enabling the elderly to continue working for far-longer than their body might otherwise allow. 

Addressing Social Determinants At The Core

Research from Leavitt Partners tells us that while clinical care accounts for about 20 percent of health, human behaviors, physical environment, and social and economic factors determine the rest. This is huge! It is also something we can’t afford to ignore.

With greater recognition of the deep-running problems across the American healthcare system and the long-road ahead to improve them, now more than ever before there is a call for healthcare providers, tech firms, local organizations, the rest of the private sector, policy-makers and governments to work in collaboration. Closer relationships that share insights mean that more accurate pictures of population groups can be formed. Technology should and can be the enabler in this.

Benefiting From Investment
After Montefiore Medical Center in New York saw a 300 percent return on its investment in housing, which drove a reduction in the admittance of patients to the hospital, it’s unsurprising that companies like Humana are investing nearly $7 million in partnerships and collaborations with local organizations to address social determinants outside clinical settings. In a bid to improve the health of its members by 20 percent, Humana’s program will address community challenges including food insecurity, social isolation and financial stability to help reduce the occurrence of conditions such as diabetes and heart failure.

Seeing positive outcomes as a result of both gaining better insights and then being able to implement an informed action-plan based on evidence, will help healthcare providers drive similar programs and initiatives that move toward benefiting the health of broader population groups.

Understanding social determinants won’t happen all at once, or from suddenly rolling out a whole new approach - it will come in phased stages. However, without taking these essential steps to understand the broader social picture of populations, healthcare providers cannot expect to implement long-lasting change that improves overall health and wellbeing of communities across the United States. Technology enables practitioners to access individual patient data and gain insights from this data through analytics to apply wider learnings about broader population groups. This data helps arm health professionals with insight allowing them to take steps toward bettering how they implement care. Through connecting medical and social determinants of health data across multiple sources, practitioners can form a broader, more informed picture of patients that enable them to start tackling problems from the root.

About The Author

Derek Ross is Business Leader of Population Health Management at Philips.