What Are Social Determinants of Health and The Impact on Health Plans

A multitude of natural and environmental factors can impact health, quality of life, and functionality for individuals. These factors are called social determinants of health. But what are social determinants of health specifically and how do they impact health plans? Social determinants of health are the life and environmental conditions that impact the quality of life for individuals. Social determinants include where people are born, live, play, learn, work, shop, eat, and worship. Age and access to quality healthcare also affect health and quality of life.

Social determinants of health create ripple effects to deeper health disparities and inequities. For instance, food deserts create a lack of access to quality food, which leads to higher risks for hypertension, heart disease, obesity, and diabetes. This leads to poorer health outcomes not just for individuals, but for populations, which leads to negative impacts on healthcare and health plans

Major Social Determinants of Health Examples

Let’s get into the specifics with some social determinants of health examples.

Living Environment and Conditions

When living conditions are subpar, it can be difficult to think about things outside of the current circumstances – including healthcare as a whole, but preventative care in particular. This social determinant of health can include factors like crime rate, quality of housing, and other social and community factors like access to public transportation and recreation. Pollution and poor air quality compound health-related issues for everyone that lives and works in these negatively affected environments.

Access to Quality Healthcare

If you can’t easily get to a doctor, it can cause you to fall behind on treatments, medication, and consistent health guidance. Also, being underinsured or uninsured contributes to disparities and limitations with healthcare, all of which lead to worse overall outcomes for patients and communities. According to the CDC, about 1 out of 10 people in the U.S. are uninsured. Health plans need to optimize how individuals and employers get access to their plans and work to close the gaps in healthcare equity and access.

Financial Status

Poverty and being un- or under-employed usually create a negative domino effect that limits access to healthy choices and quality healthcare. According to a recent U.S. census, 1 in 10 people lives in poverty. For Americans living near or below the poverty line, high quality care is often out of reach due to unaffordable insurance premiums. Health plans that cover low income individuals and populations need to prioritize value-based care to help close these gaps.

Nutrition and Access to Healthy Food Options

Financial status and where you live can limit access to nutritious food. A healthy diet provides many benefits for well-being. Unfortunately, a consistently healthy diet isn’t an option for many underserved and underrepresented individuals. This reality presents an opportunity for health plans and other organizations to help provide healthy food options to underserved communities. Every little bit helps when it comes to improving health outcomes for people impacted by this social determinant of health.

Access to Quality Education

According to the National Institutes of Health, highly educated adults in the United States have lower yearly mortality rates than less-educated people in every age, gender, and racial/ethnic subgroup. Education creates opportunities to break through negative circumstances and move up from a suboptimal environment. Specifically, education can help provide the information needed to make better health-related decisions.

Family Status and Relationships

Family relationships at home can impact the living environment for better or worse. Negative relationships with family members can increase stress for every individual in the household. And stress is not ideal for physical health nor mental health. The following is an eye-opening quote from the article, Family Relationships and Well-Being:

“The quality of family relationships, including social support (e.g., providing love, advice, and care) and strain (e.g., arguments, being critical, making too many demands), can influence well-being through psychosocial, behavioral, and physiological pathways.”

How Social Determinants of Health Impact Health Plans

When one subset of a population is negatively impacted by poor health outcomes, it lowers the overall health of the community. Health plans are affected by the social determinants of health that hinder individuals and families in the U.S. in numerous ways, including:

More poor outcomes for individual patients which leads to overall poorer community health

More complex management of health care for patients

Harder management of health disparities

More difficult to build trust and connections with underserved communities

Increased operating costs

In Conclusion: What Can Be Done?

Getting to the heart of each social determinant issue mentioned above (and those not mentioned) is the only way to improve each one. Individuals and families need real resources that can improve their situation. Equal access to quality housing, food, and healthcare are key to closing these disparity and equity gaps.

What are social determinants of health and what can health plans do to close these gaps? They need to become more socially conscious and actively involved in reshaping how healthcare is valued and delivered. Health plans should focus on value-based care and alternative payment models. This elevates providers who help close these equity and access gaps while providing meaningful care to patients across all demographics.