Acknowledging Economic Stability as a Primary Social Determinant of Health

The concept of holistic, or whole person, care continues to gain traction as the best way to address the healthcare sector’s overall mission of improved health outcomes, lower costs and improved patient experiences. Understanding the role of social determinants of health (SDOH) has become a primary focus for providers, payers, consumers and government agencies because of their demonstrated impact on the health status of many high-risk individuals in our country.

Economic stability, and its contributing factors, are a fundamental determinant currently impacting the health and well-being of many individuals. Daily struggles around unemployment, poverty, housing instability and food insecurity all contribute to an increased risk of poor health outcomes for vulnerable groups of people. Some might argue that it is not the healthcare system’s role to solve these problems; however, it is clear that identifying and empowering individuals to overcome the barriers raised by economic instability and other SDOH is the only way that our system can meet the healthcare needs of the most vulnerable in our society.

Maintaining Employment and Socioeconomic Status

The COVID-19 pandemic has created significant economic stress in the form of unemployment, underemployment and decreased incomes. Socioeconomic status is a metric that considers an individual’s income, education level and job status. There are many factors that can affect socioeconomic status such as race, ethnicity, language and geographic location. Individuals with lower socioeconomic status have less income stability which creates social determinant barriers to positive healthcare outcomes. It has been well documented that economic stress and instability can worsen chronic mental and physical health conditions such as depression, heart disease, obesity and diabetes.

The Domino Effect

Income instability can cause a SDOH domino effect — creating unhealthy outcomes, excess costs and poor patient experiences. Unstable incomes can lead to unreliable transportation, substandard housing (overcrowded, pest infested, poor heating/cooling, lead or asbestos problems, etc.), poorly located housing (high crime area, food deserts, long distance to care, no available public transportation, etc.) and food insecurity. Food insecurity is an often-overlooked health problem in the United States. According to the United States Department of Agriculture, food insecurity may range from “reduced quality, variety or desirability of diet,” to “disrupted eating patterns and reduced food intake.” The latest estimates from Feeding America are that 1 in 8 Americans will experience food insecurity in 2021.

All of these SDOH factors create healthcare issues including poor availability and access to healthcare providers and medications, inability to adhere to care plans, increased exposure to communicable diseases and the health consequences of poor nutrition.

What Can We Do?

There is now widespread recognition of the negative impact that income instability can have on multiple SDOH that affect an individual’s health. However, addressing the problems can be very challenging. Important tools for healthcare payers include enhanced care management, population health programs and outreach. These types of programs require time and scarce resources — technology is critical to using these resources efficiently and maximizing the impact across populations.

Advanced predictive analytics can identify individuals most at risk of poor outcomes including both hidden risk (people with unidentified chronic conditions) and rising risk (those who will develop chronic conditions without intervention). Analytics can be used to help prioritize and guide the work of care managers and population health program directors. Analytics also can help monitor which programs, payers and providers are most effective in addressing SDOH factors and achieving desired outcomes. Sophisticated care management software platforms can make the assessment and development of care plans for patients more effective and individualized. These platforms can enhance information sharing among all caregivers for an individual. Effective patient engagement and outreach through multi-modal messaging and mobile digital platforms can educate patients and empower them to overcome barriers to good health.

Income instability creates daunting SDOH challenges for many individuals in the United States. While healthcare payers can’t solve income stability problems directly, they can blunt the negative impact on health by using technology enabled care management, population health and outreach programs.

Gary Call, M.D., is the chief medical officer at Gainwell Technologies.