Social Determinants Explored: How Economic Stability Impacts Health

   

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As the poverty crisis in the United States continues to affect populations' health and well-being across the country, there is progress afoot: The poverty rate in the U.S. fell to 10.5 percent in 2019, marking the fifth straight year that the rate has declined.

That stat is especially promising given that it was only 10 years ago that the U.S.'s poverty rate hit a 30-year peak, following the Great Recession's economic devastation. But to truly move the needle on poverty, more work needs to be done to explore the impact of economic stability in healthcare and patient outcomes.

That work begins with recognizing that poverty isn't just a matter of someone receiving an income that doesn't sufficiently support their families' needs. Poverty can also be reflected in a person's poor health, food and housing insecurity, isolation, lack of agency, and so much more.

Simply put, the health of a population is affected by the risks and behaviors exhibited within that population and by a range of economic and social conditions that surround them—otherwise known as the social determinants of health (SDoH).

Economic Stability and SDoH

In a famous 1942 report by British academic and civil servant William Beveridge, "Social Insurance and Allied Services," Beveridge  identified what he termed the "five giant evils" that needed to be confronted and defeated to guarantee a peaceful, prosperous, and equal society for the United Kingdom: 

  1. squalor
  2. ignorance
  3. want
  4. idleness
  5. disease 

To Beveridge, analyzing disadvantage meant looking beyond income poverty alone and, instead, analyzing at the relationships among the giant evils.

Inspired by Beveridge's work, a 2016 report from the Brookings Institution provided a 21st-century update on the "five giant evils," citing five dimensions of poverty in the U.S.:

  1. low household income
  2. limited education
  3. lack of health insurance
  4. concentrated spatial poverty
  5. unemployment

In essence, the Brookings report's dimensions of poverty represented the major social determinants of health, which have been proved to impact 60 percent of a person's overall health. Using American Community Survey data for 2014 to look at the general adult population, the Brookings report found that each dimension of poverty affected anywhere from 11 to 21 percent of people. Nearly half the population faced at least one dimension of poverty. According to the report, nearly a quarter faced at least two, with nine percent and two percent facing at least three and at least four dimensions, respectively.

Those figures are sobering when thinking of the manifold ways that a lack of economic stability can amplify the SDoH that contributes to overall health—from inadequate health insurance and a lack of access to health services to housing and food insecurity, struggling educational systems, and difficulty accessing reliable transportation.

The Impact of Economic Stability in Healthcare 

Addressing economic stability and SDoH is integral to healthcare and community organizations looking to drive positive health outcomes. In fact, research by the National Center for Biotechnology Information suggests that the number of deaths in the U.S. due to SDoH, such as a lack of education, segregation, and other social factors, may be comparable to the number resulting from heart disease, lung cancer, and other leading causes of death.

A lack of prioritizing and addressing economic stability and SDoH in the American healthcare system goes a long way in explaining why the United States, despite offering some of the best healthcare services globally, lags behind much of the developed world in terms of life expectancy. The United States ranked 43rd among all countries for life expectancy in 2015. And when looking solely at OECD countries across the globe, the United States disproportionately favors healthcare over social services as a means to improving health outcomes: In OECD countries, nearly two dollars are spent on social services for every dollar spent on healthcare, but in the United States, only about 55 cents goes to social services for every healthcare dollar.

So how can public health services in the U.S. better address inequities in SDoH? The Centers for Disease Control offers a 10-point plan that promotes economic stability and SDoH as key mechanisms for driving positive patient outcomes:

  1. Make SDoH measures a foundational element in addressing community health problems and inequities, and ensure community health assessments include SDoH measures to optimally engage communities and multisectoral partners.
  2. Include community-level determinants of health in investigations and policies and practices related to other sectors supporting those efforts.
  3. Ensure outreach and education efforts address social and structural determinants of health inequities, such as access to culturally and linguistically appropriate approaches to community health to help address SDOH, as well as confronting such challenges as structural racism and stigma against immigrants, both of which can decrease the likelihood of seeking healthcare.
  4. Collaborate with community members and nontraditional partners associated with social determinants of health, including housing authorities, local law enforcement, schools, and community organizations.
  5. Leverage evidence-based policies in non-health sectors that affect SDoH and health outcomes—such as safe and affordable housing and full-day kindergarten—and develop health improvement plans at the local level that include and address the SDoH.
  6. Develop strategies that enforce existing regulations and laws affecting health, such as housing and health codes.
  7. Educate community members about their eligibility for and access to entitlement programs like Medicaid and SNAP.
  8. Support staff training and development efforts that incorporate SDoH inequity into individual job responsibilities. 
  9. Ensure evaluation and research designs include interventions that address SDoH, using performance management and quality improvement methods to explore and address the root causes of issues more effectively, including SDoH.
  10. Expand research agendas to include SDoH and related health outcomes, especially in the evaluation of natural experiments where a project is already addressing SDoH but is not studying health effects.

Empowering People and Organizations to Better Address SDoH

When it comes to addressing SDoH and economic stability in healthcare, there's clearly a lot that needs to be done to connect the dots—and that's where Healthify enters the scene and gets down to work.

Since our founding, Healthify's mission has been clear: Help build a world where no one's health is hindered by their need. We're fundamentally rethinking how healthcare organizations and communities work together to help people thrive—whether it's building partnerships that identify social needs, leveraging new technologies that make data around social services and population needs at the community level more accessible, or coordinating care with an integrated network of community partners.

Learn more about the ways Healthify builds networks of healthcare and community-based organizations that can empower people with the resources, connections, and technology they need to address SDoH and drive positive patient outcomes.

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