Addressing Social Determinant Factors That Negatively Impact an Individual's Health

There are many different factors that contribute to a person’s health beyond healthcare. Social determinants, including where an individual is born, live, work, and age, can negatively influence a person’s health, and minimizing the negative aspects of these factors can greatly benefit individuals by improving access and outcomes while lowering costs, as a new report from America’s Health Insurance Plans (AHIP) explains.

“The places where people live, learn, work, play, and worship impact a person’s overall health. The financial, social, familial, and educational aspects of a person’s life, as well as the physical environment in which the person lives, are termed the social determinants of health (SDOH),” the AHIP report explained. The CDC has identified social determinants as being shaped by “money, power, and resources that people have,” and, furthermore, that they can be “subject to policy choices.”

Negative SDOH include poverty, poor access to education, employment status, unhealthy housing, and exposure to a general disadvantage. The main result of such adverse factors is stress, which can lead to an increased risk of many diseases including obesity, diabetes, depression, and inflammatory and autoimmune disorders. This is especially prevalent considering that researchers estimate that individual behavior determines the overall health and risk of premature death of an individual by 40%.

In order to change the negative impact of social determinants, the CDC has encouraged the development of programs to improve these aspects in people’s lives. For example, the CDC has begun its Healthy People 2020 initiative, which consists of 1200 objectives with 41 topic areas that specify the importance of public health.

“To work towards these goals, the Healthy People 2020 initiative seeks to explore how programs, practices, and policies affect the health of individuals, families, and communities; establish common goals, roles, and ongoing relationships between the health sector and the targeted areas for advancement; and maximize opportunities for collaboration across federal, state, and local partners,” the authors explained.

Additionally, federal, state, and local government stakeholders have created strategies to address the effects of SDOH. CMS launched the Accountable Health Communities model in 2016, which forms community partnerships among providers and nonmedical social support groups.

The AHIP report identified several policy options that can help address negative SDOH:

• Permit greater use of “in lieu of services,” in which Medicaid covers services it normally wouldn’t as long as those services are appropriate to the person’s needs and substitute a covered service at a lower cost.
• Increase flexibility in Medicaid waivers, which could allow states to cover specific non-medical services that address SDOH.
• Create a pathway for interdisciplinary/interagency waivers, which would allow state Medicaid agencies to partner with other state agencies. One example is partnering with a state housing agency to receive a joint waiver from CMS and the Department of House and Urban Development to provide health homes for homeless individuals with mental health needs.

“Many stakeholders, from state Medicaid agencies and policy makers to providers and health plans as well as community-based services, recognize the importance of broadening medically-focused care programs to include elements that address SDOH and individual behaviors,” the report concluded. “Addressing social and behavioral factors has the potential to increase the effectiveness of healthcare and associated health care dollars, thereby improving outcomes and overall health.”