Wellness & Social Determinants of Health
A few decades ago, being “healthy” meant not having diseases or other physical problems. In recent years however, the wellness movement has gained momentum, reflecting a more holistic approach to health. The healthcare field now recognizes that health is more than just physical wellbeing.
The National Wellness Institute (NWI) has identified six dimensions that contribute to wellness. These include: physical, emotional, social, intellectual, spiritual, and occupational factors. It defines wellness as “an active process through which people become aware of, and make choices toward, a more successful existence.”
The journey toward wellness means making good choices and many wellness programs have focused on actions that individuals can take to feel better and to live longer. The results of some initiatives, however, have been mixed. Many healthcare experts are now recognizing that wellness programs, sometimes included as supplemental benefits, must also take social determinants of health into account.
What Are Social Determinants of Health and Why Are They Important for Wellness?
Social determinants of health or SDoH are the conditions where people live, work, and learn that affect both quality of life and health outcomes. Healthy People 2020 breaks SDoH down into five categories: economic stability, education, social and community context, health and health care, and neighborhood and built environment. Research suggests that enhancing the quality of life in these categories can have a significant, positive impact on population health outcomes.
As early as 2007, researchers suggested that genetics account for only around 30% of a person’s health and 70% of health outcomes are the result of social determinants of health. In 2018, the American College of Physicians (ACP) published a position paper focused on improving patient care and health by integrating social determinants of health into the healthcare system.
Last year, Dr. Jack Ende, president of the ACP, stated, “This is your zip code, not your gene code. This is where you live, how you grew up, your environment, the level of food security that you have, the level of emotional security that you have at home, economic status, and the like. We now really do understand that these can be very influential in health and healthcare outcomes.”
Innovative SDoH-Based Approaches to Wellness
Recognizing the impact of SDoH on health has opened the door for new research, funding, and program innovations. A few examples include:
- Park Rx America. This nonprofit is decreasing the burden of chronic disease and increasing health and happiness through “prescribing nature.” A diverse group of healthcare professionals is routinely writing prescriptions for time outdoors. A written prescription creates a greater sense of accountability in patients. Healthcare systems are also partnering with parks to reduce barriers to outdoor activity. They provide transportation to green spaces and programs to engage children. One example is Oakland’s SHINE program, sponsored by the UCSF Benioff Children’s Hospital Oakland and the East Bay Regional Parks District.
- Mitigating Health Effects of Adverse Childhood Experiences. Kaiser Permanente recently announced a $2.75 million investment in research to reduce the negative health impacts on children of abuse, neglect, household dysfunction, substance abuse, divorce, parental incarceration, domestic violence, and living in high crime neighborhoods. A 1998 study by Kaiser Permanente and the CDC found that children with four or more adverse experiences were 12 times more likely to attempt suicide. Those with six or more adverse experiences saw a 20-year reduction in their life expectancies.
- Payer Sponsored Programs. In 2018, Medicare Advantage services were expanded to address SDoH. For instance, homebound seniors can now get food delivered, as well as transportation to medical appointments. Last year, Blue Cross Blue Shield also launched its BCBS Institute which is developing business alliances to address SDoH. The Institute’s tagline is “addressing barriers to health – one ZIP code at a time.” Its programs include addressing food deserts, breaking down transportation barriers, and more.
Incorporating SDoH into wellness programs and supplemental benefits means addressing the underlying obstacles to better health and the root causes of health issues. With as much as 70% of health issues associated with social determinants of health, this looks like it could be a promising approach to moving the needle on persistent problems like obesity, diabetes, high blood pressure, and more.
How is your organization tackling social determinants of health and are you building them into your wellness programs?