Rashi Venkataraman, AHIP
Executive Director, Prevention & Population Health on June 26, 2019
Efforts to address social determinants of health include better
understanding patient perceptions, support systems
After caring for her husband for 12 years
before he passed away, 86-year-old Joyce Bigelow became homeless and moved into
her truck. Her Kaiser Permanente care team
connected her with housing and community resources. Her story
shows why it’s so important to address patients’ social needs, such as the
ability to have a safe and reliable place to live.
Research shows that conditions such as safe,
affordable housing and access to healthy foods are closely linked to health
outcomes. In fact, some researchers say clinical care may only account for 10%
of overall health. The real drivers of overall health are individual behaviors,
social circumstances, and environmental factors.
Health insurance providers continue to create
innovative programs that address non-medical issues. They’re also investing in
research to better understand how their members think about these needs, so
they can design interventions and resources to reach the right patient at the
right time and in the right way.
One such study from Kaiser Permanente found
that social needs are a significant source of stress for American families,
regardless of their income. And patients recognize that health isn’t narrowly
defined by the clinical care they receive – respondents said stable housing
(89%), balanced meals (84%), reliable transportation (80%), and supportive
social relationships (72%) are important to overall health.
The value of supportive social networks was
also underscored in 2018 research from
global health service company Cigna. It found that nearly half of Americans
report sometimes or always feeling alone (46%) and that Generation Z (adults
aged 18-22) have the highest loneliness scores. Further analysis from Cigna also
looked at what individual factors such as daily behaviors and demographics like
gender, race, and income are most related to loneliness. To help address
loneliness, Cigna is working to connect the dots across health and well-being
services with a new program, Health Accelerated: Life
Connected®. It addresses whole health needs and explores 5
dimensions of well-being:
1. Physical
2. Emotional
3. Environmental
4. Financial
5. Social factors
Through this work, Cigna aims to deliver a
more streamlined, proactive, and coordinated support system to improve health,
productivity, and peace of mind.
How patients view their social needs often
differs from how researchers and journalists cover these issues. For example,
individuals emphasize influences that impact them daily – finding the right
doctor for their condition, whether they have the support of their family,
according to a study from Anthem’s Public Policy
Institute. Researchers and journalists, on the other hand, often
focus on structural factors – education, income level – in part because these
factors are easier to measure.
And not surprisingly, a patient’s diagnosis
affects their perception of social needs. The availability of social and
family support was much more important for people with cancer or mental health
conditions, compared to those patients with diabetes. And concerns about access
to healthy food and diet were more prominent in patients with diabetes.
With all this mind, it’s essential that people
with social needs have support and tools they can rely on. However, according
to the Kaiser Permanente study, 35% of people lack confidence they could
identify the best resource for transportation, food, housing, or social
isolation. This is where the role of health care providers may come in:42%
would turn to their medical services provider when looking for help with their
social needs and 30% would turn to their health insurance provider for this
information. The majority of survey respondents say their medical provider
should ask them about these needs during visits.
Health insurance providers have
long-recognized the role that social factors play when it comes to accessing
clinical care. Moreover, they’re committed to investing in sustainable
interventions that match up with what their members need to live happy, healthy
lives.
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