Risks and Implications of SDOH

Despite the nation’s advancements and level of health care spending, resources directly linked to effective care are not equally accessible or integrated with health care delivery across communities, populations, and socioeconomic, racial, and ethnic groups. The contributing factors, known as social determinants of health, are community-level conditions in the environments in which people live, work, play, worship, and age. Over the last decade, there has been growing recognition that a patient’s zip code is a better indicator of his or her health outcomes than genetic code. (National Quality Forum Leads National Call to Address Social Determinants of Health. (2019. Retrieved from (https://www.qualityforum.org/NQF_Leads_National_Call_to_Address_SDOH.aspx.)

Data source: National Environmental Public Health Tracking Network (2019. Retrieved from https://ephtracking.cdc.gov/.)

The above speaks volumes. At the same time, the national and regional issues require a concentrated effort on all of us but in a different forum. Therefore, I would advocate a grassroots approach to social determinants of health (SDOH). By that, I mean starting where we work and with our team to create awareness.

Having an awareness of the risks and implications of SDOH is the focus of this “Insights.”  My question is, does your team understand the facts and risk factors associated with the SDOH domains?  For instance,

Families are considered “at-risk” for homelessness if they are low-income and spend more than half of their household income on housing. Recent data suggest that in large urban and smaller metro counties where homelessness is more common, 6.7 million households – nearly 1 in 10 – could be considered “at-risk” for homelessness.  (The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute. County Health Rankings Key Findings 2019. Retrieved from https://www.countyhealthrankings.org/)

OR

Rural risk factors for health disparities include geographic isolation, lower socioeconomic status, higher rates of health risk behaviors, limited access to healthcare specialists and subspecialists, and limited job opportunities. This inequality is intensified as rural residents are less likely to have employer-provided health insurance coverage, and if they are poor, they often are not covered by Medicaid. (2019. Retrieved from https://www.ruralhealthinfo.org/topics/rural-health-disparities#disparities-and-inequities)

These are just two examples to aid us in thinking about developing awareness of those risks.  It is incumbent upon us as leaders to share the facts with our teams.  Learning about the facts, risks, and implications of SDOH known in our community is important. I believe it is the first step in creating awareness.  Awareness and sensitivity to the issue build proactive behaviors in our teams.  We will see the results of the proactive behaviors in more thorough assessments, improved treatment team discussions, and better transition planning for the patient. 

So how do we foster that appreciation?  Consider looking at your community, county, and the area your hospital serves.  Review the hospital’s mandated community health needs assessment. Here are a few websites to get you started:

https://www.ruralhealthinfo.org/

https://www.usa.gov/statistics

https://www.commonwealthfund.org/publications/maps-and-interactives

https://www.ahrq.gov/research/findings/nhqrdr/chartbooks/ruralhealth/index.html

http://www.qualityforum.org/Measures_Reports_Tools.aspx

See what the data reveals. Then, share and explain the data with your teams. 

Then after completing educational training, think about having awareness round table discussions—dialogue with your team about the risk factors and the associated implications for patients and families.  Please encourage them to talk about real patient situations.  Help them spot the risk factors.  Help them to appreciate the risk factors in a new light. Finally, discuss actions they can implement when working with patients or families, or treatment teams.  The actions could include revising the assessment tool to include SDOH domains, providing education and training on motivational interviewing, developing partnerships with community agencies, etc.  The possibilities are endless.

Awareness is the start of addressing SDOH in your community and hospital; it will influence the entire care coordination process. But, more importantly, it will have a positive impact on the patient and their family.