Research into the social and economic determinants of health (SDOH) has revealed how best to manage sick and aging populations. Unfortunately, governments are coming to terms with decades of neglect for these factors, which have grown into a full-blown public health crisis. I hate to be the bearer of bad news, but it needs to be said: managing SDOH is not just an opportunity to improve wellness and control costs. There are real and growing downsides to letting things continue as they are--and a failure to take proactive steps to address them will have serious implications to be borne out by hospitals, Medicaid budgets, employers, and citizens.
Generation Z (those born between 1995 and 2015), which began entering the U.S. workforce in recent years, may very well be the first generation to realize a shorter life expectancy than its parents. The continued annual increase in health care spending has not resulted in a healthier population.
I will defer to my colleagues with a background in economics to fully explain the corresponding U.S. fiscal crisis. Suffice it to say, the United States is entering our 50th year of a growing health care crisis. As of 2016, U.S. health care expenditure was approximately 18 percent of our gross domestic product (GDP).
Despite these huge increases in health care spending, the United States still faces unprecedented rates of obesity, type 2 diabetes, hypertension, and cardiovascular diseases. Shockingly--for the first time in our global history--more people are dying from non-communicable disease (NCD) than from communicable diseases. Although we are spending significantly more for care, projected longevity is going down. Why and how are we failing to improve the health of those we serve?
What Are the Social Determinants of Health?
In 2014, Health Affairs reported, to the surprise of many of us in clinical medicine, that socioeconomic and environmental factors drive 60 percent of health outcomes; whereas, genetics and health care contribute to only 40 percent of outcomes. Clearly, we needed to expand our current focus on treating illness to a broader emphasis on maintaining wellness by addressing SDOH.
There are many definitions of SDOH. The World Health Organization has published a 10-factor model that has been very influential in international development contexts. Many advanced economies around the world, as well as many states, have developed their own list of SDOH factors.
Healthy People 2020 has organized another excellent framework that...