It’s a simple concept on the surface of a complex reality: Patient outcomes are not affected by health care alone.
The quality of a patient’s care actually accounts for only 10% of his or her overall health, research shows. Add genetics to the mix, and you’re still left with just 40% of the factors that determine a person’s health and risk of premature death.
What else is there? Individual behavior accounts for 40%; social circumstances, 15%; and environmental factors, 5%. Together, they outweigh the effect of the genes a person is born with and the quality of health care he or she receives.
Social determinants — the conditions in which a person is born, grows, lives, works, and ages — have a huge impact on health. Break that down even further, and you’ll come across factors including socioeconomic status, education, and employment.
Consider stress. Stress is higher when you’re living in a dangerous neighborhood, when you can’t pay your bills, when work is demanding yet unrewarding, or when you lack a supportive network of friends and family.
Stress is also a threat to wellness and health. Stress has been linked with a higher risk of obesity, depression, cognitive impairment, diabetes, coronary vascular disease, and inflammatory and autoimmune disorders.
The interconnectedness of life circumstance with stress, and stress with health status, is real and far-reaching. Yet it’s just a single example of how life circumstance plays into the health outcomes of a particular patient.
An inability to access nutritious food regularly, a lack of transportation to keep health care appointments, or a job that places workers in unsafe environments are just a few other examples of the influence of socioeconomic factors on health.
During a panel discussion at the recent US News Healthcare of Tomorrow Conference, health care providers discussed how to address social determinants of health.
"To not deal with the social determinants of health means we won't deal with population health," said Pedro J. Greer, MD, chairman of the department of medicine, family medicine and community health at Florida International University, according to US News & World Report coverage of the discussion.
Dr. Greer and other panelists urged large health care systems to work with local community groups to tackle social determinants of health rather than going it alone. Joint efforts build trust and more effectively pinpoint effective strategies that can help.
Responding to local residents concerns, Florida International University, for example, launched efforts to hire more local high school grads and to offer tutoring to school-age students, he said.
The problem may seem massive and intractable, but an increased focus on social determinants of health can, over time, bring about change, the panel agreed.
Garth Graham, MD, MPH, president of the Aetna Foundation, cited improving life expectancy rates among African-American men as an encouraging example of recent positive change.
“Nothing in life,” Dr. Graham quoted his mother, “is inevitable.”