PwC Report Urges Action to Tackle Social Determinants of Health

The world is getting wealthier, but populations are getting sicker despite rising rates of healthcare spending, and unless urgent action is taken to address social determinants of health (SDOH), governments and health systems will not see the kinds of improvements they might expect given the level of expenditures they are making. The costs related to chronic illness such as diabetes, cardiovascular disease, and even cancers, driven largely by obesity, is threatening to swamp healthcare budgets, not only in poor countries but in well-off ones as well, according to a report from PwC’s Health Research Institute (HRI).

SDOH—the social, economic, and environmental factors that influence health outside of a medical setting, such as economic inequality, pollution, lack of access to healthy food or outdoor spaces for recreation, social isolation, and more—combine to keep people from being as healthy as possible. PwC said that by 2025, many countries will see obesity/overweight rates exceeding 68% of the population.

Governments and health systems can save money in the long term and improve health outcomes by investing earlier in SDOH strategies that help people with housing, exercise, mental health, as well as the ability to afford costly prescription drug medication, the report said.

The PwC report describes 5 ways healthcare stakeholders can improve SDOH influences.

Build the collective will—and start talking about the issue

Although a casual observer might note that papers and sessions about SDOH fill up academic journals and conference sessions, actual discussion about it is not taking place. More than one-third of respondents surveyed in PwC’s 2019 HRI global consumer survey indicated they had not engaged in conversation with any stakeholders about the nonmedical, nonclinical factors affecting their health. Forty-three percent of consumers surveyed mentioned they had discussed those factors with physicians, and with pharmacists, therapists, nurses, and other health specialists even less often. Someone must act as a convener to get the conversation started, PwC said, whether it is government, corporations, or insurers, and show the long-term benefits to each stakeholder of preventing more illness.

Develop a common framework

A common framework that sets clear roles and defines value and decision-making processes will allow partners to move forward. Increasingly, consumers expect an integrated, seamless healthcare experience; roughly one-third of consumers told HRI there is room to better connect healthcare and social services.

Generate data insights to inform decision making

Predictive analytics can illuminate areas to target for health improvement that will create the most impact, which also means fewer resources (time and money) wasted on ineffective interventions. In addition, predictive analytics can encompass both individual behavior and the behavior of populations. While consumers do feel some individual responsibility to make a health or lifestyle change, 47% of respondents to PwC’s 2019 HRI global consumer survey indicated providers are not sharing predictions about what healthcare services these patients may need in the future, considering their medical history. In addition, if people are motivated, they often lack the information or tools to prevent chronic conditions.

Engage and reflect the community

SDOH strategies must be based in the way people live and work. For instance, while more than half (56%) of consumers told HRI they use or plan to use their smartphone to support their heath, technology can only work if it is embraced and trusted by the community members expected to use it. Retailers, technology providers, home health workers, and educators could provide new ways to engage with consumers.

Measure and redeploy

Partners and stakeholders must use evidence to fine tune and expand SDOH efforts and to keep all the players accountable. The report suggests 2 types of metrics that are likely to be most useful—financial and biological. Financial metrics include medical cost savings, cost benefit analysis, return on investment, social return on investment, and cost per health condition. Biological metrics include such things as body mass index and cholesterol levels, while population health metrics include life expectancy, disability-adjusted life year, etc.

“Innovative medical treatments are rendered ineffective if people don’t have social support and access to resources readily available to help keep them well,” said Kelly Barnes, the head of PwC’s Global and US Health Industries area. “This is not optional; healthcare and government organizations that don’t act on social determinants will spend more and more money, only to watch health status decline.”