Why should we be systematically leveraging SDoH? The evidence…

As I wrote in my earlier blog on Determinants of Health what struck me immediately on reading about the Determinants of Health was the fact that most of us talk about only one of these determinants – Health Services, when talking about matters related to our health. Sometimes we ‘include’ the Genetic Determinants in these references.

What about the other three – Environmental, Individual and Social Determinants?

While we instinctively understand that the Environmental, Individual and Social Determinants have an impact on our health we do not systematically leverage these determinants for better health outcomes. Should we be doing that? Spending our time and attention on systematically leveraging these ‘other three’ Determinants of Health.

The logical thing for me to do was to look for evidence on the significance of these ‘Non-medical’ Determinants. The more significant amongst them being Social Determinants of Health – SDoH.

About 6-7 years back when I started looking for such evidence I did not find much. However, I had the good luck of meeting Dan Buettner at a HIMSS conference a few years back. I heard him speak about his experiences and started tracking the Blue Zones communities. More about that in a minute…

However, while I did not find evidence of impact of SDoH at that time, other, bigger and better minds than mine were already at work and had been thinking along the same lines. I was not aware at that time, but there were experiments already under way. They started publishing results of their efforts. Starting in 2015-16, I saw evidence on the impact SDoH on health outcomes starting to trickle out. That trickle of evidence has turned into a flood in the past couple of years.

Some notable examples of such studies are those from the Blues Zones project and the 2014 County Health and Rankings study from Robert Wood Johnson Foundation. Depending on how you look at these numbers they indicate that the impact of SDoH on Health Outcomes is an improvement of anywhere between 30% and 50%.

That is HUGE.

Obviously, those ‘on the hook’ for our Healthcare dollar have taken note. Insurers, ACOs, MCOs, Self-Insured entities. As a result, most of the larger Health Insurers have initiatives that seek to systemically leverage SDoH. Bold Goals from Humana, Building Healthier Communities from CVS-Aetna to name a couple.

A couple of things were fairly evident from this research. The first is that we are not leveraging SDoH for better outcomes.  Second – that SDoH have a significant impact on our health outcomes.

So… it is quite clear that we should be leveraging SDoH. The brings up the following questions…

How can we leverage SDoH systematically?

And what does leveraging SDoH really mean?


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