By Jake Soberal
Community is much more likely to affect patients’ overall health than the time they spend with their physician. Patients’ homes, schools, workplaces, and neighborhoods all contribute to their ability to stay healthy, avoid preventable conditions, and recover from injuries. Without question, hospitals play a huge role in the well-being of their community, but as they work to improve the overall health of the people they serve, there is more to consider than just healthcare itself.
As we recover from a worldwide pandemic—a crisis that has cost millions of lives and crippled economies, infrastructure, and governments—many healthcare organizations are realizing that they can achieve far better outcomes if they consider all of the social determinants of health (SDoH).
According to the World Health Organization, SDoH are defined as “the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness.” They can be grouped into five domains:
- Economic stability
- Education access and quality
- Healthcare access and quality
- Neighborhood and built environment
- Social community and context
The SDoH have a major impact on people’s health, well-being, and quality of life. What’s more, they also contribute to wide health disparities and inequities. Economic/financial barriers often underlie the other determinants of health and are the most difficult to address. For example, without access to high-wage, high-growth jobs, healthcare can be out of reach, making preventive care unlikely. This in turn means patients miss opportunities for early intervention and treatable conditions become more serious, making subsequent care increasingly expensive.
According to Healthy People 2030, a data-driven arm of the U.S. Department of Health and Human Services, one in 10 people live in poverty in the United States, with many people unable to afford healthy foods, healthcare, and housing. Promoting healthy choices, while incredibly important, cannot be—forgive the pun—the cure-all.
Without the means to support healthy choices, communities below the poverty line struggle with chronic diseases, and hospitals are left dealing with the aftermath. Emergency room visits, mortality rates among younger patients, and even healthcare staff burnout are all higher in areas that serve underprivileged individuals. To turn the tide on these issues, hospitals can’t go it alone. It’s going to take a collaborative network of change-makers to fully address the breadth of impact that SDoH have on a person.
Workforce development can often be the foundation for addressing the other SDoH. It starts with the simple idea that by training people from marginalized communities for high-growth, high-wage jobs, they will be able to improve their lives in countless other ways. It’s worth noting that for SDoH to be impacted, these jobs need to lift people out of the lower third of the economy. Providing the skills for a low-wage, hourly position has little chance of impacting where a person falls on the SDoH spectrum. The workforce training must provide the skills for high-growth, high-wage jobs to impact the SDoH and permanently launch the job-earner out of vulnerability.
When people have access to fulfilling work that provides upward mobility within their communities, they are able to stay in their neighborhoods and improve them. The areas of poverty that were once a stress on the healthcare system now have the resources to make healthier choices. People with discretionary income often invest in themselves first, finally addressing non-urgent health conditions they’ve been ignoring, and that radiates out to their families and communities.
Obviously hospitals and healthcare providers play a key role in addressing several of the SDoH, but they can also partner with organizations that are addressing the other SDoH to have an even greater impact. If healthcare leaders look for organizations focusing on inclusive and equitable workforce development, technical training, and (especially following the pandemic) reskilling people for jobs in the digital economy, they can build partnerships that will positively affect patient outcomes.
According to a report by the Brookings Institute, low-wage earners were hit hardest by the pandemic job loss, and this sector has had the hardest time getting back to work. Before the pandemic, low-wage workers were already struggling to earn enough to support themselves and their families. “There simply were not—and are not—enough jobs paying living wages for people without college degrees (which make up the majority of the workforce) to escape low-wage work,” the report notes. Coaxing people back into the workforce with only the lure of low-wage jobs fails to serve our economy well and hurts the health of our country.
The spread of COVID-19 and the events of 2020 exposed the deep flaws that have existed for decades in the United States and laid bare the unsustainable nature of our current systems/policies that trap people in a cycle of poverty. As a result of racist and classist policies, millions of Americans are starving, have lost their homes, or have become homeless, and thousands have died without access to affordable healthcare. The SDoH, and specifically economic stability, should be a priority for all healthcare leaders.
A study cited by the National Academy of Medicine found that medical care itself only accounted for 10%–20% of the contributors to people’s health outcomes. That means, holistically, the many SDoH play a much bigger role in influencing a person’s actual health. And while we seemingly cycle people through factors of economic stability—food security and housing security—they’re just that, an unending cycle.
Around one in 10 people in the United States are living without health insurance. In 2018, 9.7% of Black Americans did not have health insurance. Among white Americans, this rate was 5.4%. Improving healthcare access starts by improving a person’s access to the skills that can garner them a job that provides a living wage and health insurance.
Improving community health isn’t something that can be done simply in the exam room; it must be part of an overall strategy, with hospitals working alongside other businesses and organizations to turn around the dismal statistics for low-income individuals. This broad coalition model is gaining traction across the country and showing promise. If healthcare practitioners consider what patients encounter outside their doors, they will have a better chance at improving the outcomes within their hospitals and in the larger community.
Jake Soberal is CEO and co-founder of Bitwise Industries, where he leads the company in vision casting, real estate development, and strategic initiatives.