Addressing social determinants of health: 3 considerations from US Surgeon General

When considering the influence of socioeconomic factors on health, the link between the two seems obvious. However, the U.S. healthcare system has not traditionally incorporated this reality into the way it operates.

Hospitals have largely functioned as human repair shops for illness and injury. However, as reimbursement becomes more closely tied to health outcomes and the emphasis on population health management grows, healthcare providers are increasingly realizing the need to address social determinants of health in addition to providing acute care. Central to illness prevention is health equity, according to the U.S. Surgeon General, Vivek Murthy, MD.

"We are at the leading edge to transform healthcare in our country," Dr. Murthy said at the Root Cause Coalition's First Annual National Summit on the Social Determinants of Health in Chicago. "But we won't fulfill our potential if we are only pouring our money into the healing aspect of healthcare. We must move upstream and fully address the factors that drive health."

Two guiding principles should guide healthcare forward as the industry continues to evolve toward value-based care delivery systems, according to Dr. Murthy. First, healthcare organizations must increase investment and attention on prevention, and second, the benefits of treatment and prevention should be accessible to everyone.

Dr. Murthy outlined three central thoughts for addressing social determinants of health.

1. Socioeconomic factors pose insurmountable barriers to health for many people. While serving as an internal medicine physician prior to his 2014 appointment as U.S. Surgeon General, Dr. Murthy realized certain factors that influence people's health cannot be remedied alone with information to support healthy lifestyle choices.

"I realized I could advise my patients to go for a walk after dinner, but if going on a walk through their neighborhood put them at risk for getting shot or mugged, or if there weren't any sidewalks, they weren't going to go," he said at the summit. "I could tell my patients they should buy healthy foods, but if investing in nutritious but more expensive choices meant there wouldn't be enough food for their kids to eat, they would go hungry instead."    

This reality — which is the case for many millions of people around the nation — substantiates the need to address various social determinants of health. Hospitals must not only provide excellent care within their walls, but they must also forge partnerships with outside organizations and work with communities to help ensure residents have access to affordable healthy food and safe environments for practicing physical activity.

2. Healthcare organizations and community partners must work together. An essential component of improving health equity is clearly articulating the importance and value of addressing social determinants of health to the various community organizations and governmental departments that each plays a hand in people's health.

"It's still news to many people who don't have the word 'health' in their title that they can make a big impact," said Dr. Murthy. "When I talk to people in housing, urban development or education, they don't typically think of themselves as health agencies, but their policies have direct impacts on health."

In addition to clarifying how different groups and organizations influence the health of communities, these sectors must convene to talk about how they can work together and make a difference, according to Dr. Murthy. "No one is lacking things to do and budgets are perennially short," he said. "Asking folks to do more is daunting, but making an investment upfront can make their jobs easier and work better in the long term."

Dr. Murthy gave the example of insulating a house to illustrate his point. High-quality insulation can be expensive, but the investment is worth it because eventually it will enable a family to spend less on heating.

3. Emotional well-being and mental health cannot be overlooked. Emotional well-being and mental health are critical components of overall health alongside nutrition and physical activity, according to Dr. Murthy, but they are "underappreciated and often unrecognized," he said. He clarified that these two elements of health are more than just controlling or preventing mental illness — they're about ensuring that individuals' minds and spirits are healthy enough to maximize their contributions in school, work and their families.

Emotional well-being is tightly linked to health, as low levels can increase risk for stress, chronic disease, social isolation, cognitive decline and early death, according to Dr. Murthy. However, studies have shown people can cultivate higher emotional well-being by acquiring strategies that help them build resilience to stress, including physical exercise, meditation, expressing gratitude, building strong social connections and getting enough sleep.

"If we focus on emotional well-being and recognize we can proactively cultivate it, then we have an added toolbox when it comes to improving health," especially in communities that have limited access to medical care, said Dr. Murthy.

Along the same vein, it's crucial to do everything possible to reduce the risk of trauma and violence in communities, as these wield significantly negative influences on emotional and physical well-being. Dr. Murthy cited success in Chicago's Becoming a Man program, a youth guidance program, in which total arrests have fallen 28-35 percent and violent crime arrests dropped 45-50 percent while kids were in the program as of July, and high-school graduation rates increased 12-19 percent, according to Chicago Magazine

More articles on population health management:
US life expectancy declines for first time since 1993: 5 key takeaways
Camden Coalition awarded $1.65M to expand 'hot-spotting' model to other cities
4 essential considerations when addressing social determinants of health

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