Can digital connectivity help us address SDOH?

Internet connectivity is a social determinant of health. Lacking access or the ability to afford WiFi or a smartphone can deprive individuals of the interconnectedness many of us take for granted on a daily basis. I mean, have you checked your screen time report on your own mobile device lately?

Personally, I consider myself to be functionally adept at using consumer technology. When I download a new app or unbox a new piece of consumer tech, I’m generally competent enough to have it up and running in a matter of minutes, as I suspect you may be. I always assumed this was due to my exposure to technology and the ability to, in most cases, be able to access and afford it. When I first started working with vulnerable populations, such as those struggling with food insecurity, housing instability, chronic illness, behavioral health challenges, living at or below the poverty line, I made some assumptions about the technology literacy and capabilities of individuals who may be called “vulnerable”. I am now embarrassed by these assumptions, given how wrong I was.

In my previous role with Commonwealth Care Alliance and its subsidiary, Winter Street Ventures, I helped to identify and shape mainstream technology to better serve vulnerable populations in Massachusetts. A cross functional team of clinicians, operators, and analysts worked to better understand the technology needs gap in complex populations, and source solutions for some of these challenges. It turns out, however, many gaps were in our assumptions. In many cases patients were far ahead of our own knowledge in consumer technology. They had tested numerous products, developed use cases, and customized products to meet their needs - they made technology work for them in a way that people or clinicians simply could not do.

This exposure to the resilience and creativity of many individuals in situations far different from my own gave me an appreciation for their approach to problem-solving, and a reminder to question my assumptions more often. That being said, there were - and still are - a number of fundamental challenges preventing many individuals from reaching increased technological independence. This has been a subject of academic and health services research, and the findings could not be more clear.  

• Dr. Julianne Holt-Lunstad’s 2010 study, Social Relationships and Mortality Risk: A Meta-analytic Review, studied more than 300,000 people worldwide and highlighted the connection of loneliness and mortality. Reports following Holt-Lunstad’s show that social isolation and loneliness has similar health impacts as smoking 15 cigarettes per day. While much of this research pertains particularly to seniors, I can only imagine that someone living alone or experiencing homelessness has a higher chance of also experiencing severe isolation. 
• In her research on Health Impacts of Unlimited Access to Networked Transportation in Older Adults, Dr. Leslie Saxon at the University of Southern California concluded that older adults with chronic disease who are taught to use networked transportation services like Lyft, in addition to fitness monitoring devices like Fitbits, report less social isolation and increased quality of life.
• I have found it helpful to learn more about the distinction between loneliness, which is a subjective feeling of being alone (perceived isolation), and social isolation, which is a complete or near-complete lack of contact with society (actual isolation.) Both loneliness and social isolation are important indicators of our physical and mental health. Dr. Carla Perissinotto at UCSF has researched how the healthcare system can do a better job of documenting these challenges and intervening appropriately, including the journal article A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults.

At Activate Care we are working with organizations who are thinking differently about how to care for populations with complex health and unmet social needs. One way to think differently is to shift how we view technology, particularly internet access, and incorporate it into our understanding of what constitutes a social determinant of health. This opens a whole host of resources, support services, blogs and forums, and with them the sense of community and belonging that is often at risk of missing among our country's chronically underserved populations.

We would like to thank UCSF SIREN - Social Interventions Research and Evaluation Network for compiling resources on social interventions, including several which were consulted for the creation of this blog post.