COVID-19: Magnifying the need to address social determinants of health

Social Determinants of Health (SDOH) once again took center stage during this year’s AHIP Institute. While SDOH has been a buzzword bellwether for several years, this year’s conference discussion centered around organizational responses to the global COVID-19 pandemic, and particularly, how the pandemic may compound the complexities of SDOH and drive health (and health care) disparities.

One session hit this topic head-on: “Using the Power of Data and Analytics to Drive Better Health,” led by Karen DeSalvo, MD, MPh, MSC, Chief Health Officer at Google Health and David Rhew, MD, Chief Medical Officer of Worldwide Commercial Business at Microsoft.

In her opening remarks, Dr. DeSalvo called the current COVID crisis an “accelerant” for organizations to put their theoretical strategies to address SDOH into action. Because many health plans had infrastructure in place, they were able to ramp up services and delivery systems to address increased SDOH concerns quickly. Specifically mentioning the importance of access to food and transportation, DeSalvo said, “We know that these matter when someone is very sick, but it also matters every day.”

Indeed, one in seven American adults have trouble getting enough food[1], and hunger and food insecurity contribute an additional $179 Billion in added costs to the health care system.[2]  Access to healthy food has become particularly problematic during the pandemic — many food banks are overwhelmed, senior centers and congregate sites may have temporarily shut their doors, and individuals managing chronic conditions are more at-risk for the disease.

Dr. Rhew noted the relationship between those who may be at-risk for COVID and additional SDOH factors, such as economic stability. He shared an innovative program spearheaded by Providence Healthcare, FedEx, and Kroger that created a home-delivery system to help individuals receive a condition-specific food package for a week. Dr. Rhew underscored the need to measure progress through data, to continuously learn and adapt based on success.

Early pilots point to potential success for condition-specific meals. A recent study, for example, found that people with chronic conditions who received condition-appropriate home-delivered meals for an average of 12 months (median 9 months) had 16% lower health care costs compared to matched controls.[3]

In closing remarks, each speaker reiterated the now-urgent need to bring these data and learnings to benefit our public health system, such as by additional progress for Interoperability standards through HL7 and our ability to deploy resources where they are needed most — whether that is PPE and ventilators or food.

Sources:

[1] https://labblog.uofmhealth.org/industry-dx/even-before-covid-19-many-adults-lacked-stable-food-supply

[2] : Chen, et al., (2001). Journal of Advanced Nursing 36 (1), 131-142) http://www.bread.org/sites/default/files/downloads/cost_of_hunger_study.pdf

[3] JAMA Intern Med. doi:10.1001/jamainternmed.2019.0198.  Published online April 22, 2019.