Look outside the clinical setting to improve population health

October 16, 2018
Adrienne Rupp, Senior Director of Marketing


Graphic representing social determinants of health

For the past six years, I’ve had the honor and privilege to serve on the Endowment for Health’s board of directors, an organization committed to improving the physical, mental and social well-being and reducing the burden of illness for all people in New Hampshire, focusing particularly on vulnerable and underserved populations.

Health equity and the impact of social determinants of health (SDoH) guide much of the foundation’s work and is the basis for funding various health equity leadership programs, including the Leadership Learning Exchange for Equity (L2E2), which brings together white leaders from throughout New Hampshire – from business and industry, education, government, social services and nonprofit sectors – to reflect, learn and act to address incidence of racial bias and discrimination.

This work, which is being done in parallel with leaders of color in New Hampshire, explores the impact of invisible systems that have benefited people who are white and the implications for the social, political and economic health of New Hampshire. The goal of L2E2 is to help white leaders better understand these invisible systems of privilege and to develop meaningful partnerships with each other and their colleagues of color to advance health equity in New Hampshire. I am currently participating in the fall cohort.

Looking beyond the clinical care setting

Many of us are now understanding better what most in healthcare have always known – that so much of what happens outside of the clinical care setting affects health and well-being. Recent research suggests medical care accounts for only 10 – 20 percent of health outcomes while the other 80 – 90 percent are attributed to demographic, environmental and socioeconomic factors and individual behavior, collectively known as SDoH. Race, ethnicity and linguistic background are key parts of the SDoH equation and are why the Endowment for Health is devoting resources to broadening the collective understanding of equity in New Hampshire and its impact on health and well-being during all stages of life.

When we look broadly at factors outside the clinical setting, we can begin to see patterns and predictors of future health outcomes and realize that the only way to truly improve health and well-being is to address the underlying SDoH.

Take cancer disparities, for example. The impact of race and socioeconomic status on cancer outcomes is well-documented. According to the Centers for Disease Control and Prevention:

  • People with lower socioeconomic status (SES) have disproportionately higher cancer death rates than those with higher SES, regardless of demographic factors such as race/ethnicity.
  • Studies have found that SES factors (access to education, certain occupations, health insurance and living conditions ) are associated with an individual’s or group’s risk of developing and surviving cancer – more than race or ethnicity.
  • SES appears to play a major role in influencing the prevalence of behavioral risk factors for cancer (tobacco smoking, physical inactivity, obesity, excessive alcohol intake, health status), as well as in following cancer screening recommendations.
  • For all cancers combined, cancer incidence rates between 2007 through 2011 were the highest overall in black men (587.7 per 100,000 men) compared to any other racial or ethnic group.
  • African Americans have the highest mortality rate of any racial or ethnic group for all cancers combined and for most major cancers.
  • For all cancers combined, the death rate is 25 percent higher for African Americans/blacks than for whites.

A study published this past summer in the journal Cancer showed that children are also not immune to health disparities, with black and Hispanic children being more likely to die of certain childhood cancers than their white counterparts.

Looking upstream with SDoH and analytics

At Geneia, our vision for tomorrow’s healthcare system, where physicians and care teams have the tools, data and insights needed to collaborate and deliver true personalized, patient-centered care, is a system designed and functioning with shared and complete data that can be easily stored, accessed, analyzed and transformed to allow for more informed, more appropriate, more effective and more personalized care.

SDoH has always been a crucial missing piece of the equation. After all, if factors like demographics, socioeconomic status, transportation, housing, food insecurity and neighborhood stress account for 80-90 percent of health outcomes, how can we possibly hope to improve population health without addressing them?

In one example, the solution to an elderly patient keeping appointments with her doctor might be a care manager recognizing her lack of access to transportation. In another example, perhaps the key to helping a young man quit smoking isn’t only to refer to a smoking cessation program but to also better understand some of the underlying social, environmental and behavioral factors that contribute to continued addiction.

SDoH play a large part in the work we do at Geneia, constantly improving our work to do a better job of looking upstream. Our data science team continues to build, test and refine models that incorporate social determinant data. Our technology platform uses the data models to produce insights and analysis.

Our population health engagement specialists use the information to prioritize, outreach, engage and educate patients. Our clients make treatment decisions, recommendations and referrals based on complete data.

We’re all working together to make care of the whole person – the physical, mental and social well-being, in keeping with the Endowment for Health’s mission statement – a reality.


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