social determinants of health,


By all accounts, Covid-19 has amplified the discussion around critical health disparities and inequities that have plagued the United States and its most vulnerable patient populations for generations. The past year has exposed how disease does in fact discriminate, and that socioeconomic challenges exacerbate the symptoms of illness. As a result, the healthcare industry has accelerated its efforts in addressing the social determinants of health (SDOH) by introducing initiatives that specifically target these deficiencies. While well-intentioned, these programs will struggle to make a tangible impact unless we increase our nation’s health literacy.

Currently, nearly 300 million Americans score below proficient in health literacy and this crucial shortcoming is pervasive among the entire continuum of age, race, vulnerability and income. And despite the fact that social determinants can drive up to 80% of health outcomes, only 21% of Americans are even familiar with the term.

The key to unlocking the full value of the SDOH is improving health literacy at scale. To do so, payers, providers, life science organizations, government or anyone else seeking to improve the health of Americans by addressing social determinants must understand the following five steps that are necessary, linear, sequential for improving health literacy.

  • Obtain a Person’s or Population’s Ability to Access Information

The first step towards achieving proficiency in heath literacy is verifying that a person is able to obtain the necessary data and information pertaining to their health, and that they have access to the appropriate guidance and support to process it. It is critical to identify the personal and community levels of social risk at baseline that create barriers to attainable information and support.

For example, does a person have the means to procure and effectively use broadband internet or a smartphone? Do they live in a data desert that exacerbates the digital divide? Do they have access to community health workers within their community, and if so, what is the frequency in which they can receive support services? Are they able to schedule and attend regular appointments with their healthcare provider?

Answering these questions facilitates a deeper understanding of literacy gaps and establishes a foundation for the continuation of the health literacy life cycle.

  • Put the Risk into Cultural Context

An essential component of advancing community-based health literacy is communicating clinical information with relevant social and cultural context. This is critically important for people to process information because cultural context varies for each person and community. Taking this into consideration when presenting information exhibits empathy and builds trust.

Health leaders and community programs have spent decades talking at people about disease. In order to enact change, they must listen to how the disease fits within the social and clinical context of the disease within the community. This allows for the risk to be put into cultural context and enables patients to process the information with an understanding of how it will impact them and their loved ones. Humans innately gravitate towards their own advancement and this must be taken into account when evaluating the community’s ability to improve health outcomes.

  • Identify Comprehension Obstacles

After discerning if a person has the capacity to obtain information and process it within their own cultural context, the next step is to address potential comprehension obstacles at both the individual and community levels to ensure they understand what that information means. These challenges are most commonly associated with education level, cultural influences and primary language, and it is important to apply community resources to address and utilize a relationship-based care approach as they arise.

The relationship-based care approach fosters enhanced comprehension at an individual level, as it embraces simplified communication and affirms understanding by monitoring for a variety of verbal and non-verbal cues. Information should be conveyed at a fifth-grade education level and provided in writing. Ensure someone isn’t simply parroting a response by asking them to repeat the information back with a frame of reference while also observing non-verbal cues. This will guide patients through the basics of disease awareness and compliance.

The key at the community level is to understand the contours of social risk and how they impede community-based health programs’ ability to connect with their target population. The most pervasive forms of social risk include food insecurity, housing instability, transportation, economic and social isolation. With these in mind, it is imperative to tailor treatment plans and programs that will repress these barriers that coexist within communities.

  • Support Peoples’ Decisions

The decision on which direction a person pursues with their health is of their own accord. While it’s important to present all options, desired outcomes and make suggestions, people ultimately choose whether or not they will take prescribed medication as directed, enroll in a vaccination program or seek treatment for chronic conditions.

The role of organizations looking to improve health at scale is to determine if people are competent enough to make an informed decision at the present moment. Competency is measured through the application of the health literacy life cycle, which confirms they are able to obtain, process and understand the information. Once this is proven, organizations must support the decision that is appropriate for the patient and their individual situation.

  • Develop a Relationship-Based Care Model

Achieving optimal health and improving outcomes is reliant upon the whole view, which accounts for clinical and social factors. Individuals seek counsel from trusted advisors when making health decisions in an effort to contextualize social risk, cultural risk and healthcare risk. The way to establish this trust with people is to operate with a relationship-based care model.

A relationship-based care model is the ability to understand, listen and form a bond with people. The failure to employ this model has caused our nation to exhibit some of the lowest levels of health literacy among developed countries. Providers, payers and others have been unable to present information in a culturally competent manner and therefore, people become unsure of who to trust.

It is imperative to have both access to health information and a trusted relationship to guide choices, irrespective of age, gender, denomination or race. That is how we are going to address the social determinants of health. The absence of information and trust will perpetuate the decades-long cycle of socioeconomic disparity because communal understanding is the foundation of health equity. People don’t want to just receive treatment or medication; they want to be cared for. That starts with listening to their concerns and delivering information in a way they can understand. As a country, we must do a better job supporting people and communities throughout their health journey because communities with greater access to information and increased levels of health literacy will ensure better health outcomes. If we do not improve health literacy at scale, we will not unlock the full impact of our expanding social determinants of health programs and concurrent efforts to address health equity nationally.

Photo: vaeenma, Getty Images



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