Amid the Pandemic, What Can we Learn about the SDoH?

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Original story posted on: March 23, 2020

In the hope of finding a silver lining, there may be a small yet significant upside to result from the current global crisis: a focus on the importance of information sharing of health factors, as well as non-medical social factors.

Throughout history, viruses and diseases have posed a threat to the global population, just as COVID-19 is today. However, with the ease of air travel supporting the connectivity of people from different parts of the world, threats in the modern age can be more significant, in terms of the speed in which disease can spread. COVID-19 has put communities and entire countries on lockdown, with citizens ordered to stay home and practice social distancing. The virus outbreak that started in a single city just months ago has since spread to almost every corner of the globe, effectively causing a halt in daily activities and a potential global economic catastrophe.

Individual citizens and business and political leaders alike are closely following updates on COVID-19, attempting to understand the situation and discern numbers of relevance as things evolve. The updates are compiled of data collected from multiple sources, which is critical in obtaining guidance for individual citizens as well as government leaders. Among the many lessons that undoubtedly will be learned from the experience of this pandemic, arguably at the center of it all, will be the critical importance of global information-sharing in a transparent, collaborative manner.  

The virus is thought to spread mainly from person to person, and specifically between people who are in close contact. The U.S. Centers for Disease Control and Prevention (CDC) has made available information about different ways to help prevent the spread of the virus, offering recommendations such as washing hands often, avoiding any touching of the nose and mouth, and staying home if you are sick.

An important question to address: how can we be sure critical information like what has been communicated by the CDC is reaching every citizen during a healthcare crisis of this nature? There are certain circumstances in which individuals do not have the resources that are required to follow such recommendations. There are also underlining issues to consider, such as financial capacity to self-quarantine, access to care, or access to the Internet for information. To better prepare for a future global healthcare crisis, it may require an examination of what the real consequences are of specific segments of the population having health inequities.

Significant evidence shows that social and environmental conditions drive health outcomes, including factors such as income, age, and living situation. For example, as it relates to COVID-19, some communities may lack trust in government officials, and therefore remain skeptical of recommendations from government bodies, such as the CDC. It may require an alternative communication process for those communities to receive critical information effectively. Neighborhood resources and overcrowded community spaces, also related to the social determinants of health (SDoH), could undoubtedly have an impact on containment. Addressing these non-medical factors could help target areas of concern, and assist in prevention.  

Is it possible that the current pandemic has exposed frailties that, if addressed, could help create a platform for implementing the integration of SDoH into global healthcare?

The SDoH are defined by the World Health Organization (WHO) as "the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power, and resources at global, national, and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries." (https://www.who.int/social_determinants/sdh_definition/en/)

There has been a steady increase in awareness of the influence of social determinants in healthcare in the U.S. This awareness, combined with a national focus on healthcare reform, has prompted lawmakers to introduce a bill creating a multi-agency council for funding for grants targeted toward addressing the SDoH: the "Social Determinants Accelerator Act." This legislation would help to improve the health and well-being of individuals in the Medicaid system, and also provide improvements in data exchange, allowing for greater coordination and accountability. SDoH are also at the forefront on a global level, with an initiative by WHO establishing a new department within the organization, The Department of Social Determinants of Health.

Though SDoH is not a new concept in healthcare, it has been slow in receiving the attention many believe is needed. They have proven to be a valuable resource for ensuring early intervention and creating better medical outcomes. To better prepare for the next outbreak, it would benefit the industry as a whole to take action and do all we can to make a healthier society, and work to decrease health inequities that have a large-scale negative impact on infectious spread.  

From the many lessons that will undoubtedly be learned from this unprecedented outbreak, one may be that addressing non-medical social factors could help prevent the mass spread of disease and the premature loss of lives from a deadly virus. Now is the time for policymakers and healthcare leaders to work together to provide an opportunity to strengthen the global view on the SDoH, and determine the scope of action.

There is much the healthcare community can expand on; the challenges associated with COVID-19 may have created an ideal setting to change the speed of action for SDoH, and ultimately help control or even prevent a future outbreak.

Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer

Susan Gatehouse is the founder and chief executive officer of Axea Solutions. An industry expert in revenue cycle management, Gatehouse established Axea Solutions in 1998, and currently partners with healthcare organizations across the nation, to craft solutions for unique challenges in the dynamic world of healthcare reimbursement and data management.

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