Social Determinants of Health in America
The concept of social determinants of health (SDOH) has gained increasing attention in recent years as an essential factor influencing health outcomes and disparities in America. SDOH encompasses many interconnected factors, such as racism, violence, discrimination, job opportunities, physical activity opportunities, language, literacy, and environmental conditions like polluted water and air. These determinants shape an individual’s access to healthcare services and the quality of care received and impact their exposure to various health risks. This essay aims to explore the multifaceted nature of SDOH in America. It will discuss the policies, laws, and initiatives implemented to improve health outcomes for underserved populations. Furthermore, the essay will examine the impact of healthcare costs on SDOH, with a focus on private insurance, Medicaid, and Medicare programs. Finally, the report will delve into the critical role managed care organizations play in addressing SDOH among underserved populations, highlighting the importance of their involvement in promoting health equity and overall well-being.
Understanding Social Determinants of Health
SDOHs are deeply entrenched in the distribution of resources, power, and opportunities within society. They are influenced by many interconnected factors, such as racism, violence, discrimination, job and physical activity opportunities, language, literacy, and environmental conditions like polluted water and air (Ogunwole & Golden, 2021). Other factors include access to healthy food, social support networks, and exposure to crime and neighborhood safety (Hill-Briggs et al., 2021; Lopez et al., 2022). These factors collectively significantly impact health outcomes, shaping people’s access to healthcare services and their quality of care. Additionally, they influence individuals’ exposure to various health risks. For instance, living in neighborhoods with limited access to grocery stores offering fresh products can lead to poor diet and increased prevalence of chronic diseases like diabetes and obesity (Hill-Briggs et al., 2021). Similarly, residing in areas with high levels of air pollution can exacerbate respiratory conditions. It can increase the risk of cardiovascular diseases (White-Williams et al., 2020). Tackling these complex factors is essential for enhancing overall health and diminishing societal health inequalities.
The influence of SDOH on health outcomes is extensively supported by research in the field. For instance, Hill-Briggs et al. (2021) found that social determinants such as socioeconomic status, race, and ethnicity significantly influence diabetes prevalence and outcomes. Similarly, White-Williams et al. (2020) highlighted the impact of social determinants on heart failure outcomes, emphasizing the need for a comprehensive approach to care that addresses these factors. Other studies have demonstrated the link between SDOH and mental health, with elements like neighborhood safety, social support, and access to resources crucial in determining mental health outcomes (Lopez et al., 2022). Additionally, Ogunwole and Golden (2021) explored the relationship between SDOH and maternal and child health, finding that factors such as education, income, and access to prenatal care significantly affect maternal and infant health outcomes. It is vital to recognize and address the complex aspects of SDOH to promote health equity. This approach contributes to the overall well-being of individuals and communities nationwide.
Addressing Social Determinants: Policies and Laws
In response to the growing recognition of the importance of SDOH in shaping health outcomes, various policies, and laws have been put in place to address the underlying factors and promote health equity. The Affordable Care Act (ACA) is a prime example of a policy that extends healthcare coverage to a broader population (Lopez et al., 2022). This expansion has been particularly beneficial for underserved Americans. It did so by broadening Medicaid and establishing health insurance marketplaces. This expansion has helped reduce the number of uninsured individuals and improved access to essential healthcare services.
Additionally, the ACA introduced provisions to address health disparities, such as requiring non-profit hospitals to conduct community health needs assessments and create plans to address identified needs (Hill-Briggs et al., 2021). Furthermore, the ACA has increased funding for community health centers, which provide primary care services in medically underserved areas, and established the Prevention and Public Health Fund, which supports initiatives targeting SDOH (Ogunwole & Golden, 2021). These efforts demonstrate a comprehensive approach to addressing SDOH and promoting health equity in the United States.
Some states have implemented policies targeting specific social determinants, such as housing and education. These policies aim to improve health outcomes. For example, New York State’s Medicaid Redesign Team has prioritized investments in supportive housing for high-need Medicaid beneficiaries, recognizing the critical role of stable housing in promoting health (Lopez et al., 2022). Efforts have been made to address environmental determinants of health, such as air and water pollution. The Environmental Protection Agency (EPA) has addressed pollution-related health risks by implementing regulations limiting pollutant emissions from industrial facilities (Hill-Briggs et al., 2021). They promote clean water resources, which is particularly beneficial for vulnerable populations. However, challenges remain in addressing the systemic racism, discrimination, and income inequality that continue to shape SDOH in America. Ongoing advocacy and policy changes are needed to dismantle these structural barriers and promote health equity.
The Cost of Healthcare and its Impact on SDOH
In the United States, the elevated cost of healthcare has consistently hindered access to essential care for numerous Americans. This issue is especially pronounced for individuals who lack sufficient insurance coverage. The implementation of the ACA has helped to some extent by expanding access to healthcare coverage, but challenges remain. For example, private insurance often comes with high premiums, deductibles, and copayments, which can deter individuals from seeking care or adhering to treatment recommendations (White-Williams et al., 2020). As a result, addressing the financial barriers to healthcare access remains crucial in pursuing health equity and improved health outcomes for all Americans.
In contrast, Medicaid and Medicare provide essential coverage for low-income and elderly populations, but they face challenges related to provider reimbursement rates and gaps in scope. For instance, low reimbursement rates in the Medicaid program may limit the availability of healthcare providers willing to accept Medicaid patients, affecting access to care for these individuals (Lopez et al., 2022). Moreover, some states have not expanded Medicaid under the ACA, leaving many low-income individuals without access to affordable healthcare coverage (Ogunwole & Golden, 2021). To overcome these challenges and ensure equitable healthcare access, ongoing efforts are needed to improve Medicaid and Medicare programs, focusing on addressing reimbursement issues and expanding coverage in all states.
Managed Care and Addressed SDOH in Underserved Populations
Managed care organizations (MCOs) are crucial in addressing SDOH among underserved populations. MCOs are responsible for delivering healthcare services to Medicaid and Medicare beneficiaries and are increasingly focused on addressing SDOH to improve health outcomes and reduce costs (White-Williams et al., 2020). MCOs can help address SDOH by implementing targeted interventions that address specific social determinants, such as housing, education, and employment opportunities. For example, MCOs can partner with community-based organizations to provide their members with supportive housing services, job training programs, or educational resources (Lopez et al., 2022). By addressing these factors, MCOs can help promote health equity and improve health outcomes for their beneficiaries.
In addition, MCOs can adopt value-based payment models that incentivize providers to focus on addressing SDOH and improving health outcomes. Through these models, providers receive rewards for offering high-quality, cost-effective care that meets patients’ needs. This approach addresses social determinants that impact health (White-Williams et al., 2020). Examples of such models include accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and bundled payment arrangements (Lopez et al., 2022). These innovative payment models encourage providers to collaborate and coordinate care, focusing on prevention, early intervention, and addressing the root causes of health disparities. This approach can aid in transitioning the focus of healthcare delivery from merely treating illnesses to promoting overall health and well-being. Simultaneously, it fosters a more equitable healthcare system.
Conclusion
Social determinants of health play a significant role in shaping health outcomes in America. Factors such as racism, violence, discrimination, job and physical activity opportunities, language, literacy, and environmental conditions contribute to health disparities and inequities. To address these challenges and promote health equity, it is essential to implement policies and laws that target the root causes of these disparities and recognize the role of managed care organizations in addressing SDOH among underserved populations. Efforts to expand access to healthcare coverage, invest in supportive housing, improve environmental regulations, and promote value-based payment models are critical in addressing SDOH and promoting health equity. Continued advocacy and policy changes are needed to dismantle structural barriers and ensure that all Americans have the opportunity to achieve their full health potential.
References
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., Thornton, P., & Haire-Joshu, D. (2021). Social determinants of health and diabetes: A scientific review. Diabetes Care, 44(1), 258–279. Web.
Lopez, K. N., Baker-Smith, C. M., Flores, G., Gurvitz, M., Karamlou, T., Gallegos, F. N., Pasquali, S. K., Patel, A., Peterson, J. L., Salemi, J. L., Yancy, C. W., & Peyvandi, S. (2022). Addressing social determinants of health and mitigating health disparities across the lifespan in congenital heart disease: A scientific statement from the American Heart Association. Journal of the American Heart Association, 11(8). Web.
Ogunwole, S. M., & Golden, S. H. (2021). Social determinants of health and structural Inequities—Root causes of diabetes disparities. Diabetes Care, 44(1), 11–13. Web.
White-Williams, C., Rossi, L., Bittner, V., Driscoll, A., Durant, R. W., Granger, B. B., Graven, L. J., Kitko, L., Newlin, K., & Shirey, M. R. (2020). Addressing social determinants of health in the care of patients with heart failure: A scientific statement from the American Heart Association. Circulation, 141(22). Web.