The Urgency of Addressing Social Determinants of Health by PwC Health Research Institute (HRI) Condensed and presented by Advanced Plan for Health (APH)
Social Determinants of Health (SDOH) is a pivotal advancement of the health care industry that is set to establish more authentic healthcare practices. This due in part to the intimate influence SDOH has on health outcomes – perhaps even more so and in a greater capacity than any other facet of the healthcare system.
In theory, a healthcare system evolves concurrently with novel technologies, concepts, and practices. Failure to adapt and respond to industry advancements naturally leads to inefficiencies that inhibit optimal outcomes and must ultimately be addressed.
To help those interested in SDOH research, APH has condensed the informative PwC Health Research Institute (HRI) report, “The Urgency of Addressing Social Determinants of Health,” into a two-part blog series that highlights reported recommendations, statistics, challenges and perceived risks of failing to address SDOH.
Below is a selection from the PwC report that presents what APH found most pertinent for our readers.
The heart of the matter….
Modern medicine, a marvel of technology and ingenuity, ushers in waves of progress that can add length and quality to human life. And yet certain powerful countervailing forces work against the efficacy of new treatments. The social determinants of health – social factors such as employment, housing, income inequality, and level of access to clean water, education and transportation – undermine progress and can swamp the health systems that ignore them. As social factors counteract medical best practices, health systems often remain focused on creating solutions at the wrong interaction point; after people are already sick and in crisis.
Countries have been spending more on healthcare every year — US$8.4 trillion across the globe.1 Yet after decades of rising life expectancy and improving health outcomes, a modern health crisis is escalating, fueled by soaring rates of obesity.2 By 2025, the Organization for Economic Co-operation and Development (OECD) projects many countries will see obesity and overweight rates exceeding 68% of the population.3
Curing disease may seem more within reach than curing the underlying societal challenges of poverty, hunger or unemployment.
But the increase in illnesses caused by people’s behaviors and where they live, and work could suffocate public and private budgets in both wealthy and poor countries.
The costs of inaction cannot be escaped. As governments, payors and communities demand more results for the money they are spending, forward-thinking leaders will seize the potential of social determinants of health to right the system so it can produce better outcomes for all. PwC’s Health Research Institute (HRI) conducted a global survey in June 2019 of 8,000 people in eight territories, along with interviews of healthcare organization leaders and an analysis of more than 20 case studies, to identify the five steps crucial to starting — and succeeding with — a social determinants approach to health strategy.
- Data analytics can spotlight the specific path to take towards true health for populations.
- Respecting and reflecting the community’s wishes ensures that programs are grounded in the reality of how people live and work.
- Programs must continually use evidence to fine-tune and improve the way social determinants affect health.
- Pursuing this path is no longer optional; all players must act, or risk being swept under by the rising rates of illness.
The world is growing wealthier, but the greater wealth of nations doesn’t always translate into the greater health of nations.
Why aren’t we healthier?
The world is growing wealthier, but the greater wealth of nations doesn’t always translate into the greater health of nations. Between 1990 and 2010, health spending by OECD countries nearly doubled.6 And yet people are getting sicker across the world. Nowhere is the threat to public health clearer than in the rising proportion of people considered overweight or obese (Exhibit 1). The epidemic of obesity makes people more prone to a slew of chronic health problems including diabetes, cardiovascular diseases and cancers.9 A comparison of outcomes and investments in Japan and the US, two of the world’s most highly developed countries, shows the behaviors and environmental factors may have more of an impact on health than money spent.10 (see Exhibit 2).12
For all the investments already made in healthcare, countries have not been able to bring about the necessary societal shifts to encourage habits that could prevent chronic conditions from developing. (see Exhibit 3).13 Consumers shoulder some blame, as 43% of respondents to PwC’s 2019 HRI global social determinants of health consumer survey said they bore the greatest responsibility for addressing the behavioral, social and economic factors contributing to their health. But that doesn’t mean they are doing anything about it, or that they even know what to do.
Social determinants such as employment status, income level, educational attainment, pollution levels and neighborhood crime all affect how people experience the world and the choices they make (see Exhibit 4).14 In PwC’s 2019 HRI global consumer survey, one in five respondents indicated they could not afford a healthy lifestyle, and a similar share said they did not have the time to focus on healthy behaviors. In fact, clinical care, while vital, is responsible for only 20% of a person’s health. The other 80% is attributable to health behaviors, the physical environment and socioeconomic conditions.15
Twenty-two percent of survey respondents who classified themselves as being in poor or very poor health said mental health concerns such as depression kept them from a healthier lifestyle. Organizations need to determine what programs and campaigns will help consumers in this frenzied mindscape eliminate the obstacles to health and motivate people towards healthier behaviors.
In a screen- filled, interconnected world, the state of our brains may be key to unlocking better health. Consumers say they are not:
- getting enough sleep,
- are distracted by smartphones,
- lack motivation and
- struggle with mental health issues such as depression and anxiety —
none of which sets the right frame of mind for healthy decision making (see Exhibit 5).
In a time of robust medical discovery and treatments that seemed impossible a generation ago, the most effective strategy to improving healthcare may lie in a focus on root causes.
- Why do they engage in the behaviors that cause their health to suffer?
- And what environmental and social factors influence those behaviors?
Any institution taking on a challenge as income inequality may seem an insurmountable task. Countries that have more inequality in income levels experience a higher rate of diabetes.16 Yet our research, work and conversations with industry leaders reveal that the data is available to build a case for urgent action, to identify where and how to conduct interventions and to inform the use of existing technology to amplify such efforts.
The PwC Health Research Institute (HRI) report does an excellent job of outlining the multifaceted complexities at the heart of the SDOH dilemma.
The sheer volume of information, labor-force and resources required to fully address SDOH may be daunting, but integration of SDOH data is unavoidable for healthcare practices rooted in evidence-based outcomes.
“Many things which cannot be overcome when they are together, yield themselves up when taken little by little.” – Plutarch
Health technologies used to support culture-oriented solutions are designed to improve outcomes today and grow with you as your business and wellbeing needs evolve. To this end, APH provides a line of sight through health information that includes clear, insightfully organized, and actionable data on the following and much more:
- medical and pharmacy claims
- health risk assessment and biometrics
- actionable predictive assessments
- behavioral health
This powerful information can be leveraged for identification, selection, intervention, and engagement. Without the pathways for identification and intervention support there is no mitigation of risk, overall health culture improvement, or return on investment.
Click here to learn about APH’s Neighborhood Environmental Index project which aims to depict through data the complex realities of social determinants and their effects on individual health.
The Urgency of Addressing Social Determinants of Health. PwC Health Research Institute (HRI), August 2019.