A Review of Social Determinants of Health, Associated Challenges, and Potential Solutions

Researchers presenting at AMCP Nexus 2019 recently summarized some of the key social determinants of health and how they impact overall outcomes for patients with complex conditions such as cancer.

Social determinants of health were defined by the authors as follows: “The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.”

One of the determinants addressed was access to healthy food and food insecurity. The authors noted that the average health care costs incurred by Ontario adults (18-64 years of age) over a 12-month span in relation to food insecurity status was $1,608, $2,161, $2,806, and $3,930 for those who are food secure, marginally food insecure, moderately food insecure, and severely food insecure, respectively. Barriers to this group include distance to supermarkets, transportation, and food deserts. Vulnerable populations typically include in low-income, rural, or minority communities, with discrimination being cited as a strong determinant within this population. The impacts of this poor nutrition are diabetes, obesity, CKD, high blood pressure, and cancer.

Access to health services and primary care was another social determinant addressed by the researchers, who noted that only 65% of adults under 65 have access to a primary care provider. These patients are less likely to receive preventative care therapies such as cancer and blood pressure screening, dental care, flu shots, and other vaccinations.

Housing quality was listed as a determinant in low-income families, with associated risks including lead poisoning, vector-borne diseases, and poor respiratory health due to mold from water leaks. The researchers also touched on health literacy as a social determinant of health, being that low health literacy is correlated with more frequent ER visits, increased hospitalizations, and poor medication adherence.

Many challenges exist when it comes to addressing these social determinants of health. The researchers listed fragmented data, the need for multifaceted interventions, barriers to language and culture, and education gaps as specific barriers to progress. They also discussed and proposed potential approaches to these issues, including targeted case management programs that leverage health risk assessments, collaborative holistic care teams, predictive analytics models that account for social determinants data, reimbursement services that aim to address social determinants, and partnerships with provider and community groups. Another innovative proposed solution involves digital cognitive behavioral therapy consisting of on-demand, web-based modular therapy programs. These platforms are created in academic institutions, backed by credible research, can be used independently or with clinical support, decrease the need for higher levels of care, and offer self-paced, convenient, HIPAA compliant solutions.



Jenny M, Leo, S, et al. Increasing Positive Outcomes: The Impact of Social Determinants of Health. Presented at: AMCP Nexus 2019; October 29 – Nov 1; National Harbor, MD.