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Social determinants of health undermining progress of modern medicine, says PwC

By investing earlier in social determinants strategies, health systems stand to save money in the long term and improve outcomes.

Jeff Lagasse, Associate Editor

The rise in illnesses caused by peoples' behaviours and the social determinants of health threatens to suffocate budgets in both wealthy and poor countries, while suppressing the power of modern medicine to improve lives.

That's the main lesson of PricewaterhouseCooper's new report, "Action required: The urgency of addressing social determinants of health," which outlines why healthcare stakeholders need to act now to combat this trend.

Social determinants of health -- or the social, economic and environmental factors of where people live and work, such as social isolation, economic inequality, pollution and food deserts -- are preventing too many people across the globe from making healthy choices. And the impact can't be ignored: PwC projects that by 2025, many countries will see obesity/overweight rates exceeding 68 percent of the population.

By investing earlier in social determinants strategies that help people with housing, exercise, mental health support and the ability to afford medications, governments and health systems stand to save money in the long term and improve health outcomes.

The results suggest that action on the SDoH front isn't optional; healthcare leaders who don't act on social determinants will likely spend more and more money on worse and worse health outcomes. But there's an opportunity for health systems and governments to target SDoH by intervening earlier to prevent or stall the progress of chronic disease, especially when it comes to obesity and diabetes.

PwC outlines five steps stakeholders can take to develop strategies to tackle SDoH challenges.


The first step is to build the collective will. Too many healthcare stakeholders aren't talking about social determinants, as only 43% of respondents to a PwC Health Research Institute June 2019 global consumer survey said their doctor has even raised the subject with them.

Other health workers, such as nurses, pharmacists and dietitians, are talking about it at a much lower level, highlighting the opportunity to involve healthcare workers more broadly. A convener can help bring partners together across the system by demonstrating the long-term benefits to each stakeholder of preventing more illness.

Step 2 is to develop a framework that enables partners to work toward common goals. Once they've done the hard work of building coalitions, partners must overcome the everyday challenges of merging disparate workplaces with different missions, incentives and perspectives.

Consumers expect that care should be better integrated to create a seamless experience; roughly one-third of consumers asked in a 2019 HRI global consumer survey indicated that there was an opportunity to better connect healthcare and social services.

The third step is to generate data insights to inform decision making. Predictive analytics can be used to consider both individual behaviour and the behaviour of populations. Many consumers do feel some individual responsibility to make a change, but 47% of respondents to the survey indicated healthcare providers are not sharing predictions about what healthcare services these patients may need in the future considering their medical history. Even if people find the motivation, they often lack the information or tools to prevent chronic conditions.

Step 4 is to engage and reflect the community. SDoH must be grounded in the way people live and work. While 56 percent of HRI consumer survey respondents indicated they use or plan to use their smartphone to support their heath, technology can only work if it is embraced and trusted by the community members expected to use it. Retailers, technology providers, home health workers and educators could provide new pathways to engage with consumers.

The final step: Measure and redeploy. In Western Sydney, a coalition dedicated to diabetes prevention in its area population set measurable goals such as reducing population weight and HbA1C levels, then started developing a diabetes dashboard to help measure which interventions worked and track trends in costs. An annual year-end review report and plan for the year ahead helped further refine its strategy and investments.


The trends in SDoH are intersecting with trends in artificial intelligence. Factoring in SDOH is possible due to data, and if AI shines in any one particular area, it's making sense of complex data sets.

If the social determinants are comprised of the socioeconomic factors that can influence a person's health -- income, education, access to transportation, etc. -- then AI has the potential to allow providers to make the best possible use of that information.

That becomes increasingly important as value-based care emerges. With reimbursement increasingly tied to health outcomes, providers have a real incentive to ensure they're delivering the best care possible.

Twitter: @JELagasse

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Focus on Social Determinants of Health

In September, Healthcare Finance News, Healthcare IT News and MobiHealthNews will take a look at the SDOH and how varied health systems, IT companies, Congress and others are addressing it.