Shining a Spotlight on the Social Determinants of Health (SDoH)

With more focus on the SDoH, public health organizations and their partners can take action to improve the conditions in people’s environments.

The social determinants of health (SDoH) are an individual’s personal circumstances that impact their health, well-being, and quality-of-life risks. They include political, socioeconomic, and cultural factors, along with how easily someone can access healthcare, education, a safe place to live, and nutritious food.

The World Health Organization (WHO) defines the SDoH as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Specifically, the SDoH describe the conditions in the place where a person or patient is or was born, lives, and works, including factors such as whether a patient is unemployed, how they worship, and how they age. They’re made up of a large range of factors that can impact the health and quality of life of a person, in particular if they live in under-served communities.

When we discuss applying these SDoH to a patient’s clinical profile, we acknowledge that these factors can directly a patient’s well-being, in positive and negative ways. For example, a neighborhood may have mass transit that makes it easy to get around and cuts down on pollution. But it may also lack grocery stores where people can buy healthy foods (ICD-10-CM code Z59.48). Or a patient may live in an area that lacks access to community health clinics or discounted pharmacies for access to necessary medications, because the patient cannot afford their prescriptions (Z91.120).

With more focus on the SDoH, public health organizations and their partners can take action to improve the conditions in people’s environments.

What Organizations Are in Charge of SDoH?

To help organizations take needed action, the SDoH Workgroup has been established with the cooperation of government agencies, including:

• Office of Disease Prevention and Health Promotion (ODPHP);
• National Institutes of Health (NIH);
• Centers for Disease Control and Prevention (CDC);
• Health Resources and Services Administration (HRSA); and
• National Center for Health Statistics (NCHS).

Members of the SDoH Workgroup are experts in various areas, such as health equity, health disparities, economics, vulnerable populations, and other matters. This group has also created objectives related to the social determinants of health.

The five key domains for the SDoH are:

1) Economic Stability;

2) Education;

3) Health and Healthcare;

4) Neighborhood and Built Environment; and

5) Social and Community Context.

Economic Stability

One in 10 people in the United States live in poverty. Many can’t afford healthy food, healthcare, or shelter. Those with stable employment are more likely to be healthy. But even those who find secure jobs may not be able to keep their position, or may not make enough money to afford the things they need to stay healthy. In addition, people with injuries, disabilities, or conditions like arthritis or diabetes might face limits in their ability to work certain jobs.

Organizations and government policies can help people pay for housing, food, healthcare, and education to improve their quality of life.

Healthcare Access and Quality

Around 1 in 10 people in the United States don’t have health insurance. These people are less likely to have a primary healthcare provider, and might not be able to afford the medications and medical services they need. It’s crucial that insurance coverage is expanded so that more people have access to important preventative care and treatment for chronic conditions.

Without a primary care provider, patients may miss out on critical healthcare services, like cancer screenings.

But before we continue to discuss the rest of the domains, it is important that we recognize how physicians can help capture the SDoH from an ICD-10-CM perspective. This is the only way that these disparities can be on the forefront of change.

How Do Experts Track the SDoH?

Within each SDoH, there are many objectives within a variety of specific topics. These objectives are measurable, and focus on high-priority public health issues. Experts are trying to use data to track how each objective has progressed over time. They group them based on their growth. But as you can see below, progress has stalled, because this information is so hard to track without good data from appropriate sources. Specifically, our healthcare providers sort progress like so:

• Baseline only. This refers to goals that don’t yet have any data, besides initial baseline information. Experts don’t know if there has been any progress made in these areas yet.
• Target met or exceeded. Experts can show that they’ve met this objective or exceeded the goal.
• Improving. Data shows that there’s progress being made toward the goal.
• Little or no detectable change. No growth has occurred to fulfill this objective.
• Getting worse. Experts found that they’re farther from their goal than they were at the start.
• Developmental objectives. These are high-priority health issues with some evidence, but they don’t have reliable baseline data yet.
• Research objectives. These are public health issues that carry a high health or economic burden or reflect a large inequality between population groups. But these too don’t yet have much associated evidence.

Programming Note: To hear more information on this topic, listen to Talk Ten Tuesdays today, when part of the discussion will focus on the responsibility of the physician and healthcare provider to contribute as much data as they have available on individual patients.

This can help providers meet these aforementioned objectives and in turn see better outcomes for populations lacking in healthcare services.

All it takes is knowing the ICD-10 codes for SDoH and how to capture them during an encounter.