By ARJUN GOSAIN
In the United States alone, one in ten people live in poverty, 10.2% of households are food insecure, and more than half of people living below the poverty line are transportation insecure. These statistics represent social determinants of health (SDOH) measures that describe a patient’s experience outside hospital walls.
Health.gov defines SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” This definition argues that a patient’s experiences are just as crucial if not more telling than their biology.
And this makes sense as a person who is housing insecure may not have the same access to nutritional food, transportation, or social support. Additionally, some patients, in their efforts to maintain health, may experience discrimination based on their skin color or religious beliefs.
Some studies have found SDOH can drive up to 80% of health outcomes. This means that the traditional healthcare model—hospitalization, healthcare delivery, and treatment—only affects a mere 20% of a person’s overall health. To tap into this 80%, healthcare professionals need data. However, SDOH data collection poses significant challenges.
Before we dive into data collection, let’s review the specific measures of SDOH and why they should take top priority among healthcare professionals.
SDOH concepts include:
- Employment insecurity: Measures whether the patient is employed and their current employment or unemployment experience. This includes whether they were harassed on the job or experiencing unequal pay. Employment insecurity can lead to financial stress, mental health problems, and reduced healthcare access.
- Psychological circumstances: Measures current events that are affecting the patient’s health. This encompasses a wide range from unwanted pregnancies to exposure to war or violence. Stress, anxiety, and other negative emotions can have a direct effect on a patient’s physical health and contribute to disease development.
- Housing insecurity: Notes whether a patient has a consistent place to live or is forced to move regularly. Homelessness or housing insecurity can lead to exposure to the elements, mental health challenges, and increased vulnerability to infection.
- Social adversity: Examines a patient’s social experience including any discrimination or persecution the individual may be facing. Increased social adversity can cause an individual to socially isolate and develop feelings of depression.
- Transportation: Observes the patient’s access to transportation including available public transport. Missed appointments can be the direct result of transportation inaccessibility which leads to a decrease in the quality of care.
- Food insecurity: Indicates whether a patient has adequate food access and safe drinking water access. Receiving adequate nutrition is essential for maintaining optimal physical health. For example, if a child is food insecure, it can lead to serious developmental issues and chronic disease.
- Education and literacy: Observes a patient’s ability to read and comprehend hospital paperwork. Note that individuals with higher literacy and education rates typically make more informed health decisions.
- Occupational risk: Examines how a patient’s current employment affects their overall health. Determines if their job site places them at risk of toxin exposure, physical harm, undue stress, or other hazardous conditions that can contribute to injuries or illnesses.
- Economic insecurity: Measures a patient’s poverty level to determine if copays, rent, and hospital bills are manageable. A patient living with inadequate finances will face a greater barrier to quality care.
- Lack of support: Notes whether a patient has reliable support when experiencing difficult circumstances such as the death of a loved one. If a patient has a present support network, they will be able to receive practical, emotional, and physical assistance in times of need.
- Upbringing: Takes a patient’s childhood, family, and upbringing into account to assess if a patient is carrying trauma from previous years. Adverse childhood experiences can increase the risk of chronic diseases and mental health issues later in life.
- Language: Examines any language or communication concerns, so that a patient can both communicate their issues and understand oral and written treatment. Miscommunications can lead to misdiagnoses and inadequate treatment.
These contributing factors cannot be ignored since, as previously stated, they can directly impact up to 80% of health outcomes. Thus, organizations that choose to neglect SDOH factors are only focused on the 20%.
This is why providers must find ways to address SDOH in a meaningful and productive manner, which is where SDOH data comes in. The collection and analysis of SDOH data can help providers identify at-risk populations to provide informed, effective interventions. Measures like patient needs assessments and population-level health disparity analysis can let providers get to the root cause without the guesswork.
SDOH Data Collection Challenges
SDOH data collection is a sensitive topic. After all, if a patient is experiencing abuse or is unemployed, they most likely would not disclose that information outright. Providers also have limited time to ask additional questions because many feel rushed during routine consultations and may not have the resources needed to collect SDOH data.
Beyond SDOH data scarcity, there is the issue of standardization. How providers collect housing data, for instance, can vary across definitions and measurements, making quantifying data difficult. So, how can providers offer whole-person care with limited data and a lack of definitive measurements? The solution is three-fold.Continue reading…