In healthcare, prevention is always preferable to reacting to an acute episode. Innovations like mammograms, glucose monitoring and vaccines have saved countless lives. Unfortunately, we aren’t taking advantage of one crucial preventive option in our communities, and it is costing not only billions of dollars, but it is costing people their lives.
Our current model stresses the need for regular check-ups to prevent things like heart disease, cancer, diabetes- we want to prevent these things from taking hold and leading to a lifetime of poor health and costly interventions. No one questions the rationale behind this, no one thinks investing in preventative care is a revolutionary idea. But why then does our current system not extend this thinking to addressing the Social Determinants of Health? According to the National Academy of Medicine social factors, such as housing, access to transportation, food security, and safety in relationships are the drivers for as much as 90% of medical outcomes, so why not a proactive approach to addressing these factors before they become costly and drive poor outcomes?
Health providers are beginning to track, and in some cases even treat, these underlying issues during patient encounters, but clinicians cannot do the work that could make the biggest difference in preventing acute medical events on their own. Proactive social care that intervenes – i.e., proactively addresses SDOH - is a key element in improving the healthcare system in the US, but requires effort from people outside of traditional settings, like hospitals and medical clinics, where care is administered.
What is proactive social care?
Social care encompasses a wide array of assistance that helps people live dignified, independent lives. Here in the US, social care programs include food assistance, housing resources, foster care, Head Start preschool programs and more.
There is also an extensive network of social workers at private healthcare institutions that offer assistance with everything from paying for prescriptions to providing emotional support. Patients who enter the hospital with critical SDOH are often connected with additional resources before they leave, enabling them to care for themselves or a loved one at home (and many times, they are not even receiving SDOH screening when they present at a care facility).
Proactive social care entails many of the same services, but they happen before a healthcare crisis hits. Access to healthy food, a safe and sanitary living space, educational opportunities and a support network can make the difference between a severe chronic condition or a long and healthy life.
Why proactive care instead of symptomatic treatment?
In an emergency situation, it is easy to see how preventing the accident is preferable to treating an injury. For example, telling a child not to climb an unstable structure may result in a temper tantrum, but this is a better outcome than a head injury due to a fall.
For SDOH, the connection is less obvious, but just as poignant. Seeking out at-risk and vulnerable populations and providing them with better options for a healthy lifestyle is preferable to treating chronic conditions later on. One illustration of this is kidney stones, which are a common reason for ER visits. Kidney stones are extremely painful, expensive to treat, and can result in risky surgeries. In many cases, kidney stones are 100% preventable through lifestyle changes. Improving health literacy – educating people about proper diet and staying hydrated - and providing healthy foods and clean water when necessary is simple, inexpensive, and could save patients and hospitals $775 million dollars each year, and employers 3.1 million lost workdays, according to a study by Dartmouth and Johns Hopkins.
Who is responsible for social care in our communities?
Social and medical care are often intertwined, and for good reason. However, clinicians simply cannot be expected to handle all aspects of holistic care. Since a patient does not walk in the door until there is already a problem, proactive care has to come from other sources.
Medicare and Medicaid, two of the largest social programs, come from federal and state government mandates and funding, with care administered by medical professionals. The government provides a variety of other social programs, but more can be done if organizations step up to fill the gaps.
Employers can offer mental health programs, incentivized healthy living programs, and a culture that allows for self-care. Schools can teach our youth about risk factors such as smoking, alcohol and obesity. School counselors and nurses can also watch for signs of abuse or early warning signs of poor health. Community leaders can advocate for the people they serve, such as the homeless population and other at-risk groups.
Above all, the various stakeholders in any community should find ways to collaborate to reduce costly avoidable events in order to get people the help they need proactively. Fortunately, tools exist to help multiple partners coordinate for effective SDOH screening, data sharing and follow through to reduce avoidable healthcare emergencies.
The bottom line
We already know that preventive care matters. The Institute of Medicine (IOM) estimates that missed prevention opportunities cost the US $55 billion every year. We need to shift our focus to seeking out the SDOH that make the biggest impact, and proactively work to address those.
Social and economic factors tend to influence health outcomes more than any other indicator, and can directly lead to serious conditions that follow patients throughout their lives. Chronic conditions account for 90% of all US healthcare costs–an estimated 3.6 trillion dollars. We can’t prevent every serious disease, but proactively caring for underlying social causes goes a long way in saving money and improving lives.
If we all work together, we can target these risks through gathering data, community outreach and proactive public policies that provide resources where they are most needed. To enable people to live a healthier lifestyle, we can give them the opportunities, education and tools they need so that healthy choices are easy instead of hard.