Leveraging the Social Determinants of Health
Recent research by Taylor, Tan, Coyle and et al examines the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending. The study reveals that interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have positive impact in terms of health improvements or health care spending reductions. This demonstrates that social services can be leveraged to improve health or reduce costs.
Overwhelmingly, studies find that non-medical factors including social, behavioural and environmental determinants of health consistently play a substantially larger role than medical factors. The literature is replete with studies dating to the 1970s that indicate that poor social determinants of health are harmful to health both in the short and longer-term as well as a growing body of literature which demonstrates the positive impact of favourable social conditions on health outcomes. Despite the evidence, an enduring challenge of the social determinants of health literature has been translating its insights into actionable recommendations.
This study sought to synthesize the existing empirical evidence about the impact of social service interventions on health outcomes and health care spending, with particular attention to identifying programs and practices that achieved both improvements in health as well as potential reductions in health care spending.
The study indicates that several interventions in the areas of housing, income support, nutritional support, and care coordination and community outreach have had a positive impact.
Findings from this work, the majority of which was conducted with low-income populations, suggest that keeping a population healthy may require medical providers to link with unconventional partners such as housing and education Moreover, while case managers and care coordinators have become a ubiquitous feature of many health care systems, the literature provides an impetus for potentially expanding the scope of services that case managers and care coordinators manage.
The study also highlights the “wrong pocket problem”, in which the savings that accompany health improvements do not accrue to the investor. Many social service interventions (e.g., income support, housing) generate positive health outcomes, yet social service sectors receive little if any reward for their contribution to the creation of health in the population. Similarly, depending on its payer and contract mix, a health care organization that contributes to a person’s health does not reap the full social benefit from those health improvements. Thus, the wrong pocket problem discourages cross-sector collaboration when in fact the literature reviewed here suggests a high degree of mutual dependence and potential reward from coordinated health care and social services. These are questions we can and should be wrestling with more explicitly, particularly as literature like this empirically demonstrates the broad range of inputs required to create health.
Read the article
 Taylor LA, Tan AX, Coyle CE, Ndumele C, Rogan E, Canavan M, et al. (2016) Leveraging the Social Determinants of Health: What Works? PLoS ONE 11(8): e0160217. doi:10.1371/journal. pone.0160217