A systems approach to community wellness: Understanding and addressing the social determinants of health

In 2017, former-U.S. Surgeon General Vivek H. Murthy wrote in the Harvard Business Review that loneliness is a serious healthcare problem.


Then, early last year, the United Kingdom appointed a Minister of Loneliness to address an epidemic that some say is worse for your health than smoking 15 cigarettes a day. And loneliness, research found, is more accurate in predicting early death than obesity.

Even payers such as Cigna are taking on the issues of patient loneliness and social isolation by offering resources and recommendations to help patients combat the problem.

What does loneliness have to do with the treatment of conditions such as diabetes? Well, quite a lot. Social determinants are key factors in how we view and treat patients holistically. We know that health conditions are shaped by a patient’s financial, physical and social circumstances. 

According to the Robert Wood Johnson Foundation, "80 percent of clinical outcomes are attributable to the social determinants of health." And, according to a July 2017 JAMA article, the average life expectancy is 15 to 20 years shorter in low-income communities than in more affluent communities.

What are social determinants of health?

According to the World Health Organization, social determinants of health are "the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems."

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As indicated by Dr. Steven Schroeder and others, social and economic factors are far stronger determinants of health outcomes than medical care. The contribution of social, economic and environmental circumstances is so strong in determining health that the WHO states "blaming individuals for having poor health or crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the determinants of health."

With this understanding that the context of people's lives is what most significantly determines their health, we must take a comprehensive and systematic approach to address social determinant to improve individual and community health.

A systems approach to community health

As we continue in pursuit of healthcare's Triple Aim — better care, smarter spending and healthier people — the social determinants of health take on even greater importance. As healthcare organizations seek innovative, holistic solutions to cost -effectively deliver care and provide better health outcomes, they must identify and address health literacy, financial instability, food insecurity and other social circumstances to meet the demands of our U.S. value-based care transformation.

To this end, stakeholders across the country are evaluating new and innovative approaches to identify and address the health-related social and economic needs of patients and communities. Some examples include:

• Early childhood education and development programs
• Safe access to green space for physical activity
• Healthy grocery options
• Nutrition services
Transportation
• Workforce development
Medical neighborhoods


Community wellness

Allscripts Paragon client Saint Anthony Hospital is taking a novel approach to address community health in the development of the 32-acre Focal Point Community Campus in Chicago.

The Focal Point Community Campus will serve as a financially sustainable community development to help improve the lives of more than 400,000 residents on the West and Southwest sides of Chicago, representing North Lawndale, Little Village, Pilsen, Brighton Park, Back of the Yards and Archer Heights neighborhoods. Construction is scheduled to begin in 2020.

The campus will offer retail, wellness, education, recreation services and workforce development customized to the needs of the community, all key components to addressing social determinants for the better.
Together, we are committed to providing comprehensive, community care like what will be available at the new Saint Anthony Hospital campus.

 

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