By: Don Gerdts (don.gerdts@3aimstrategy.com), February 1, 2022 Though health care is essential to health, it is a relatively weak health determinant. Research shows that health outcomes are driven by an array of factors, including underlying genetics, health behaviors, social and environmental factors, and health care. There is currently no consensus in the research on the magnitude of the relative contributions of each of these factors to health, and the purpose of this series is to highlight studies that suggest that health behaviors, such as smoking, diet, exercise, and social and economic factors are the primary drivers of actual health outcomes. One such study was published in January 2011 in the American Journal of Public Health titled, “Neighborhoods and Chronic Disease Onset in Later Life”. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.178640# The study points out that 8 out of 10 older adults in the United States have at least one chronic health condition. Even more, the incidence of many common chronic conditions, such as heart disease, arthritis, diabetes, and some cancers, and the costs for treating them are increasing. Although the etiology of such conditions varies greatly, literature has increasingly documented associations between characteristics of the neighborhoods in which older people live and late-life morbidity. The most studied neighborhood feature in this context is economic disadvantage. Studies have established that living in economically deprived areas is associated with higher risks of heart disease, stroke, hypertension, and a greater number of chronic conditions, but lower cancer incidence. Numerous mechanisms have been suggested as driving a linkage between economic deprivation and chronic conditions. In reviewing cardiovascular disease mechanisms, for example, Ana Diez Roux, MD, Ph.D., MPH, who is Dean of the Dornsife School of Public Health and directs the Urban Health Collaborative at Drexel University, discussed how social and physical aspects of poor neighborhoods may influence individual risk factors (e.g., physical activity, diet, smoking, and the ability to recover from stress), which in turn may influence more proximate biological risk factors (e.g. blood pressure, diabetes, body mass index, blood lipids, and inflammation). Conditions of interest for this analysis included coronary heart disease, angina, congestive heart failure or other heart problems (which we referred to collectively as “heart problems”); high blood pressure or hypertension; stroke; diabetes; cancer or a malignant tumor, excluding minor skin cancers; and arthritis or rheumatism. In the unadjusted results (Table 3 from the study), only 3 social determinants emerged as being significantly related to the onset of chronic conditions for men: 1) Living in a more economically advantaged area was associated with a lower odds (-20%) of experiencing the onset of diabetes, 2) Living in areas with a higher immigrant concentration was associated with an increased odds (+16%) of developing high blood pressure, and 3) Living in an area with higher levels of crime and more segregation was associated with a higher odds (+18%) of developing cancer. I’ll continue to highlight the linkages I can find to help inform our planning, development and allocation of resources in the healthcare ecosystem to advance as much as possible in pursuit of the Triple Aim in healthcare. As we continue to identify these linkages, the main question that I struggle with is this: As a society, how do we appropriately intervene to address social determinants of health without medicalizing them?TripleAim Strategy Advisors can help stakeholders in the healthcare ecosystem as a consultant or advisor to identify the most prevalent social determinants of health linked to health outcomes and develop strategies to address them in pursuit of improving equitable, value-based care.
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