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A patient’s health isn’t determined by how often they visit the doctor or how well they adhere to their drug regimen. There’s a range of nonclinical and environmental factors that contribute to a patient’s overall health, and those are called the “social determinants of health.”
“Most people think that health is 100% about healthcare—meaning what you can achieve by going to the doctor and getting regular appointments,” said Lynda Flowers, an independent health policy consultant with expertise in social determinants of health. “The literature says that only about 10% to 20% of health is determined by healthcare, which is important, but in and of itself, it doesn’t account for all of the things that impact our health.”
Examples of social determinants of health include access to safe housing, education, and secure financial resources. Exposure to racism, discrimination, and violence also affects health either positively or negatively.
Many health systems have programs to address various social determinants of health.
Medstar Health, which is based in the DC/Maryland/Virginia (DMV) area, partnered with Uber in 2019 to increase patient access to transportation to appointments. The program was implemented after the health system found that patients weren’t showing up to appointments largely because they couldn’t get to the centers.
Children’s Wisconsin, based in Milwaukee, started a program in 1996 called Project Ujima, which “works to stop the cycle of violent crimes through crisis intervention and case management" for children and adults in the community. One of the successes Children’s Wisconsin lists as a result of Project Ujima is “better medical outcomes after injury.”
Health systems got a financial incentive to fund programs that target the social determinants of health when the Affordable Care Act (ACA) passed in 2010. The ACA was a catalyst for a nationwide push toward value-based care. With insurers moving to a model that pays health systems for better patient outcomes, investing in programs that lead to better health outcomes potentially equals higher reimbursement.
“When you [...] help people address any of the social determinants that may be negatively impacting their health, [...] then you’re gonna get better health outcomes,” said Flowers.