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LMS President’s Message: October 2023

LMS President’s Message: Social Determinants of Health – Hidden Levers of Health Outcomes
By Lee Dossett, MD

During the annual KMA convention last month in Louisville, the educational portion of the meeting dealt with defining, recognizing, and managing the social determinants of health (SDOH) of patients.  This is a term that entered the healthcare vernacular in the last few years and was not something I learned about in my training in the 2000’s.   Intuitively, I think physicians have always recognized the social factors that affect our patient’s health and ability to access the healthcare system.  These non-medical factors wield a profound influence on an individual’s health and well-being, and it’s crucial for doctors to grasp why they matter deeply in our daily practice.

SDOH encompasses a multitude of factors, ranging from financial stability, education, and employment opportunities to housing quality, social support networks, and access to nourishing food. These conditions, in which individuals are born, live, work, and age, collectively mold their health outcomes.

Let’s illuminate the concept with real-life examples:

  1. Income and Economic Stability: Financial stress can translate into poor health outcomes due to limited access to healthcare, inability to afford medications, and compromised nutrition.
  2. Education: Lack of education often results in reduced health literacy and hinders a patient’s ability to navigate the healthcare system effectively.
  3. Housing: Substandard living conditions can exacerbate a wide range of health issues, from respiratory ailments to mental health challenges.

We know from research that your zip code at birth is a strong predictor of your life expectancy.  As you can see from the map below, Kentucky is firmly in an area of decreased life expectancy compared to other parts of the country.

Doctors should care about SDOH because they are the hidden levers of health outcomes. By recognizing and addressing these determinants, we can significantly enhance our patient care. Here’s why:

  1. Holistic Care: Incorporating SDOH into our practice allows us to provide holistic care that considers not just the symptoms but also the root causes of our patients’ health issues.
  2. Improved Outcomes: Addressing SDOH can lead to better patient outcomes by tackling the fundamental factors that contribute to illness.
  3. Reduced Health Disparities: SDOH are at the heart of health disparities. By addressing them, we contribute to a fairer and more equitable healthcare system.
  4. Patient Engagement: Understanding a patient’s social context fosters better communication and trust, leading to more engaged and compliant patients.
  5. Value-Based Care: With the shift towards value-based care and reimbursement tied to outcomes, addressing SDOH is not only good medicine but also good economics.

However, we should not be naïve in thinking that by merely acknowledging SDOH we are solving them.  In reality, we can only hope to mitigate them to some degree.  It will take a larger policy commitment from local and federal government to make marginal gains of this.  The significance of SDOH in healthcare is slowly being recognized at the policy level. Initiatives such as accountable care organizations (ACOs) and Medicaid programs now tie reimbursement to SDOH-related interventions. This approach incentivizes healthcare providers to integrate SDOH into patient care strategies to enhance health outcomes and control costs. 

Social Determinants of Health are not abstract concepts; they are real-life factors that profoundly influence the health of our patients. As physicians, it is our responsibility to understand and address these determinants to provide the best possible care. By doing so, we not only contribute to better health outcomes but also align ourselves with the changing landscape of healthcare reimbursement. Kentucky has recognized the importance of this journey, and together, we can lead the way in patient-centric care.