Socioeconomic inequality continues to be one of the most pressing issues of our age, and one very specifically linked to health outcomes for patients. While there has been great progress in the areas of medicine and healthcare quality in recent years, access to those advancements haven’t always been available to everyone in an equal way.
For some patients, barriers to access are primarily economic. For others, a combination of financial issues, transportation, education, and even community planning have resulted in barriers- not only to healthcare when they’re sick, but to the basic resources that tend to keep them healthy in the first place.
Over the last two years, rising costs in certain areas of healthcare coupled with the impacts of the Coronavirus pandemic have underscored our need to address the social determinants of health (SDoH) that give rise to these inequities within the healthcare system.
Defining Social Determinants
With respect to the basic resources mentioned above, consider factors such as having physical access to such things as food, medicine and healthcare. There have been places in the US in which the only pharmacy, grocery store and public clinic in a community closed within a short span of time, leaving an entire zip code with no access to medications, food or healthcare. In scenarios like this, those people have wound up having to travel more than twelve bus stops in order to access these things.
The impact of social determinants of health on individuals and the general population apropos health risks and outcomes is widely acknowledged, and has given rise to a great deal of study in recent years. According to Pharmacy Times, these categories of social determinants include:
- Economic stability
- Neighborhood and physical environment
- Food and diet
- Community and social context
- Health care
Research across medical science, the social sciences and business have all spurred providers, payers, and public health agencies to develop ways to address these social determinants of health, and to mitigate inequities which develop as a result. This has included everything from specialty pharmacies investing in identifying social determinants of health that could impact medication adherence and health outcomes, to efforts on the part of the government to address the issue.
Earlier this year, members of Congress launched the bipartisan Congressional Social Determinants of Health Caucus, which plans to highlight opportunities to coordinate federal investments in health and social drivers of health such as food, housing and transportation. The thought behind this initiative is to promote the idea that Americans’ health and health outcomes “should not be determined by what zip code they live in,” says Rep. Cheri Bustos (D-Ill.).
Reps. Bustos, Tom Cole (R-Okla.), G.K. Butterfield (D-N.C.) and Markwayne Mullin (R-Okla.) are sponsors of the Social Determinants Accelerator Act (H.R. 2503) that would provide planning grants and technical assistance to help states and communities address the social determinants of health for high-need patients. H.R. 2503 is intended to help states and communities devise strategies to better leverage existing programs and authorities, in order to improve the health and well-being of those participating in Medicaid.
The legislation would provide planning grants and technical assistance to state, local and Tribal governments to help them devise innovative, evidence-based approaches to coordinate services and improve outcomes and cost-effectiveness.
Thus far, the caucus has been working to highlight the disparate impact of the COVID-19 pandemic on certain populations and communities, gathering thought leaders to educate members on the evidence around social determinants, and collecting stakeholder input on how best to facilitate effective social determinant interventions.
The COVID-19 pandemic continues to shed light on numerous areas in which our healthcare system can be improved. For example: In the current environment, telehealth has become an important part of healthcare access. Yet one in four families in Representative Bustos’ district don't have internet at all, and close to half don’t have high-speed internet—which amounts to a social determinant. Thus, there are individuals who do not have practical transportation options to healthcare facilities, and they can’t even access telehealth as an alternative.
So while access to a resource like broadband was once considered a luxury, it was demonstrated during the pandemic that this factor could significantly impact a person’s health.
“Broadband is just one example of something that could be financially supported with this grant money—a rural community could get the grant and use that money to fight their broadband issue,” said Bustos.
Changing Business Paradigms—and Motivations
According to Rhonda Randall, Executive Vice President and Chief Medical Officer at UnitedHealthcare, modernizing the healthcare system, expanding care, and improving quality and affordability- and doing so sustainably-are no longer merely questions of ethics, parity and social justice—they’re sound business decisions as well.
Since 2020, UnitedHealthcare has embraced a broader and more proactive engagement process with stakeholders, conducting one-on-one interviews and discussions and applying feedback in their ongoing efforts. “We solicit input from a diverse group of stakeholders—including consumers, employees, customers, healthcare professionals, suppliers, policy-makers, shareholders and nonprofit partners—through a variety of formal and informal methods including forums, surveys and individual meetings.”
Companies with a large footprint like UnitedHealthcare have come to the conclusion that creating a modern, high-performing health system that expands access to care, improves health care affordability, enhances the health care experience and achieves better health outcomes is not only inevitable—it has become a necessity from a business perspective.
UnitedHealthcare has also been at the forefront of acknowledging the persistent and widening gaps in health and well-being by race and ethnicity, gender, geography and educational level. In June, the United Health Foundation, the philanthropic foundation of UnitedHealth Group, released its inaugural America’s Health Rankings Health Disparities Report, which went into deep detail on these issues. The report also cited that nearly all of these disparities existed well before the coronavirus pandemic broke last year.
Moving Forward: Framing the Conversation
According to Mary T. Bassett, Director of the FXB Center for Health and Human Rights at Harvard University, “COVID pulled back the curtain on the longstanding racial and ethnic inequalities in health.” Like the Congressional Social Determinants of Health Caucus and UnitedHealth’s Randall, she believes that the conversation needs to be about access to all the things that make up a healthy life, rather than just healthcare.
“Public health leaders and organizations need to talk about lives being at stake,” Bassett said. “It's beyond a moral issue—it's about our ability to live long and healthy lives. This is a societal issue that we all need to face—public health leaders need to lend a voice to it even if it means getting out of our lane.”