The Social Determinants of Health & Their Effect on Health Outcomes
HealthWare Systems Blog
on Friday, August 17, 2018
The social determinants of health are increasingly on the radar of health professionals and health systems. The National Academy of Medicine (formerly the Institute of Medicine) even recommends this information be included in patients’ medical records.
Hospitals can utilize screening tools to collect patient data concerning the social determinants of health. While a provider may not be able to resolve all social issues faced by a patient, identifying them can help inform healthcare decisions. (Providers should also have a list of resources that attend to social needs available to provide the patient when asked.)
When health systems consider the social determinants of health when caring for their patients, all parties benefit. Patients have better health outcomes, communities improve, and health systems become advocates for their patients (improving patient satisfaction) while saving money. The social determinants of health not only impact the health of patients, but also the health of a hospital’s revenue cycle.
Social factors that influence patients’ health & healthcare decisions include:
Employment – A good job can provide a patient and his/her whole family with health benefits and insurance. Unemployment negatively affects physical and mental health.
Income – A steady paycheck allows a patient to pay for many of the other factors in this list, such as adequate housing, nutrition, and transportation, as well as healthcare costs. (Financial assistance screening tools can help patients find out if they qualify for charitable programs to help offset the cost of care, and enable hospitals to facilitate the application process for their patients.)
Housing – Poor living conditions increase the risk of infectious disease, injury, chronic illness, pest and mold problems, and indoor air pollution. And each year, 1.48 million Americans have no home at all. (Here are some examples of how hospitals can help meet patient housing needs.)
Violence – The area in which patients live also can affect their exposure to violence or abuse. Victims or witnesses to acts of violence may experience mental, physical, and/or economic consequences that affect their overall health.
Nutrition – A lack of consistent access to healthy food can negatively impact health outcomes and increase the risk of many adverse health conditions. Over 12.7 percent of U.S. households were affected by food insecurity in 2015. (Read our previous blog for more information on how to reduce patient malnutrition.)
Transportation – Access to reliable transportation can govern a patient’s access to medical care. Approximately 3.6 million Americans miss or postpone medical care due to transportation issues. (Check out these ideas for addressing patient transportation needs.)
Social Support – As reported by NPR, in a recent nationwide survey conducted by Cigna “nearly 50 percent of respondents” said “that they feel alone or left out always or sometimes.” Two in five respondents “felt like ‘they lack companionship,’ that their ‘relationships aren’t meaningful’ and that they ‘are isolated from others.’” Patients who feel unsupported are more vulnerable to poor health outcomes. (Read how physician empathy can generate better health outcomes.)
Language/Culture – Culture influences our beliefs about health and healthcare. A patient’s ability to communicate with health professionals may be impeded by language barriers.
Education – According to the CDC, people with higher levels of education are more likely to choose healthy behaviors and refrain from unhealthy ones. People with lower levels of education are more likely to be obese and more likely to smoke.
Health Literacy – People with lower education levels are also more likely to have inadequate health literacy skills. People who are limited in health literacy have higher rates of hospitalization and emergency room use and they use preventive care less. (Read our blogs on reducing patient uncertainty and addressing health insurance confusion for ways to help improve your patients’ health literacy.)
Patient Engagement – A patient must have health literacy skills in order to be actively engaged in his/her healthcare. Better engaged patients tend to see better health outcomes. (Promoting health observances, using social media in healthcare, and educating patients about preparing for a doctor’s appointment are a few methods for improving patient engagement.)
Sex/Gender – Many health conditions affect men and women differently and certain treatments may be more or less effective depending on the sex of the patient. Plus, men are less likely than women to see a doctor for a specific health concern, preventive healthcare, or a standard annual exam. (Consider these tips for improving male patient engagement.)
It’s not difficult to imagine how the above factors might influence one another. The social determinants of health are interconnected and work together to impact a person’s health and healthcare decisions.
Patients whose social needs are unfulfilled are more likely to utilize healthcare resources at a higher cost (including the Emergency Department), be readmitted, miss appointments, and have poor health outcomes.
Hospitals that address the social determinants of health can create better health outcomes, reduce hospital readmission rates, and improve patient engagement while lowering no-show rates and enhancing revenue cycle management.