Blog Post | October 1, 2018

Social Determinants of Health: Shaping Patient Health from the Ground Up


Social determinants of health (SDoH) include a combination of genetic, environmental, economic, political, and social factors, as well as access to health care. Evidence shows that stress negatively affects health across the lifespan and that environmental influences may have multi-generational impacts.

Addressing SDoH is essential to reducing health disparities that are often rooted in social and economic disadvantages. Non-medical determinants of health are believed to account for up to 60 percent of health outcomes. New efforts and policies focused on addressing social and environmental influences have emerged with growing recognition of their importance on health.

Documenting the Need

Studies show a need for the development of focused interventions to address social complexity in primary care. Determinants may include economic instability, poor social support, substandard housing, hunger, lack of transportation, and limited access to quality care, all of which impact a wide range of health, functioning and quality-of-life outcomes. Research suggests that health behaviors, such as smoking, diet and exercise, are the most important determinants of premature death.

SDoH also impacts the quality of death and dying. Being non-Hispanic Black and having a low income are associated with a lower likelihood to enroll in hospice and a higher probability of receiving aggressive care at the end of life.

Call to Action

To address these issues, health care professionals, policymakers, communities, and other advocates should recognize the important role these factors play in individual and community health. Doing so will lead to initiatives and public policies that reach the largest number of people while targeting the day-to-day needs of individuals in their communities.

Efforts to address SDoH involve multi-payer federal and state programs, including those sponsored by Medicaid or led by states or health plans, as well as provider-level activities focused on identifying and addressing the non-medical, social needs of patients.

Policy Change to Medicare Advantage

Recent regulatory and legislative policy changes to Medicare Advantage (MA) are a step in the right direction. These changes provide plans with more flexibility and enable provision of services matched to individual member needs; and expand the types of services that can be covered.

These policies have direct relevance for provision of palliative care and social services for beneficiaries in MA plans. While some plans already pay for home-based palliative care, when this new legislation is enacted all MA plans will be allowed to pay for services matched to the needs of these beneficiaries, including food, transportation, personal care aides, and home-based palliative care. In response, palliative care programs should be prepared to demonstrate their value to MA plans.

Community-based palliative care programs can demonstrate their value to payer partners and their members by designing and deploying programs that: 1) put services in place to meet the needs of patients and their families, specifically those that address SDoH. 2) identify outcome measures aligned with the goals and priorities of their payer partners.

Community-Based Palliative Care

Holistic care is the cornerstone of palliative care. The advantages of in-home care in terms of addressing SDoH include the ability to assess the home environment, including factors related to safety, nutrition, health literacy and access to care.

In-home palliative care also provides the opportunity to assess caregiver needs and reduce their stress levels and financial burdens by offering culturally competent care, integrating health and arranging services from community organizations such as the Department of Aging services, financial and legal services, transportation services, food services, support groups and caregiver services.

With growing recognition of the importance of social factors to improving health outcomes, an increasing number of initiatives and programs have emerged to address SDoH. Bringing a greater focus on health within non-health sectors and addressing health-related social needs through the healthcare system is expected to improve the health of millions of people throughout the country. Focusing on these needs will also go a long way in improving access to palliative and hospice care and improving the end of life experience for all.


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