Everyone involved in the funding and delivery of healthcare is well aware of the impact social determinants have on outcomes for individuals and populations. Whether they be publicly funded or insurance based health systems, the challenge in addressing these remains the same.
Likewise health care systems and health providers experience on a day to day basis the real challenges faced by specific populations, families and individuals, in achieving equitable health outcomes when faced with challenges, many of which are created by poverty, such as poor housing, food limitation, social exclusion, negative childhood experiences and poor education.
There is no shortage of evidence to support the case for addressing these.
But the challenge in addressing poverty and the adverse social conditions that arise from it are one of societies “wicked” problems, that by definition are extremely challenging to solve.
Impacting more than 10% of health outcomes
It is well recognized that healthcare on its own can only impact on some 10% of a population’s health outcomes. The rest is down to genetics, individuals behaviors, the environment and the SDOH. For healthcare systems and providers to address these requires significant change from central government down. It requires sustained, substantive and integrated actions between healthcare, local government and social sector agencies to turn the tide.
So how can healthcare systems and individual providers play their part, outside of their usual business of prevention and treatment of disease? Whilst we wait for the policy and funding changes to occur at a governmental level, what can we do at a local and individual level to make a difference? How can I as a primary care physician or my health system as a whole improve poverty, housing conditions, education and negative childhood experiences when there isn’t the time of day or funding to keep up with what we are organized and trained to do?
One answer is to build deep and meaningful connections with the other agencies, in local government and the social sectors. To do the best we can whilst we wait for a sea-change to come from the centre and to support individuals, families and communities to navigate their way through the complexities that we put on their path, at a time when they are at their most vulnerable.
Focus on downstream effects
The second answer is to focus our attention on some of the downstream psychological, behavioral and social effects of poverty and the social determinants they create. Three of these that have well established evidence bases and have real world examples of how addressing them improve outcomes are:
- Health Literacy
- Social connectedness and the impacts of loneliness
- Psychological assets
For anyone involved in direct clinical care of a patient, the challenge of being able to impart understanding and knowledge on an individual is not new. Traditional methods of providing education often in group settings and resources written on paper have been replaced in recent times with digitally enabled solutions that allow access to support and resources at a time and place that best suits the individual and allows this to happen at scale.
In the US Department of Health and Human Sciences’ 2010, National Action Plan to Improve Health Literacy, there is described the clear linkages between poor health literacy and poor outcomes in prevention, chronic disease and self reported health status. It recognizes the adoption of innovative approaches to addressing poor literacy and calls for user centered design of content using targeted approaches and requiring organizational change to deliver this.
Social Connectedness and the impact of Loneliness
Social isolation and loneliness is becoming recognized as being associated with poorer health outcomes in people of all ages. It should be pointed out that being alone and loneliness are distinctly different, with adverse outcomes being associated with the latter. It is possible to be alone and not lonely.
While still much is to be learned about the causal relationship between loneliness and health outcomes, it is generally thought that the social isolation triggers a set of behavioral and psychological actions that are maladaptive.
As our understanding of the cause and effect of loneliness increases, the role of modern social networks in addressing this increasing problem will be of great interest.
Stress and the benefits of engagement and self efficacy
Any clinician will tell you, the vast majority of patients will, when directly asked, admit to suffering from some degree of stress. Stress is ubiquitous in our society and it has far-reaching and wide-ranging impacts.
To obtain and utilize the psychological tools to deal with stress, we must be engaged in our health and build a belief that we can have control over our own health. Improving this self efficacy is reliant on sustained and genuine engagement. It will be the providers and healthcare organizations that can show (and measure) this level and depth of engagement and the subsequent improvements in individuals self-efficacy that will genuinely be able to reap the benefits in long term health outcomes shown in the research.
Attract and retain
In this age of value-based healthcare, it will be the organizations that can attract and retain patients, by supporting them in these endeavors of improved literacy and social connectedness whilst building their psychological assets, that will be successful in achieving that value both for themselves and their loyal patients.
Discover how to attract and retain patients. Download our How To Create Supported Self-Management Checklist here.