Ask the Expert: How Do Social Determinants Impact Health?

Factors like environment, poor nutrition and access to transportation can significantly affect health.

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For over 20 years, Peter Dews, M.D., M.S., an internal medicine physician with Ascension Medical Group, has seen the impact that social determinants – like where a person lives, nutrition, isolation and access to transportation – have on health. 

“Over the course of my career, I’ve worked in homeless and rural health care, and have worked extensively with vulnerable populations – urban and rural poor, or isolated seniors – and I don’t think anyone would disagree that social determinants are a substantial influencer of health outcomes,” Dr. Dews says. According to the Commonwealth Fund, about a third of the deaths in the U.S. can accounted for by social factors. 

“While perhaps a bit of an oversimplification, on some level this could be thought of as an extension of the nature versus nurture conversation,” Dr. Dews says. “In order for anyone to have the best chance to reach or maintain their full potential, they should exist in the best environment possible.” 

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Although the picture is improving, and not purely a Detroit phenomenon, recent estimates suggest that 20-25% of Detroit neighborhoods still qualify as “food deserts,” usually devoid of fresh vegetables and fed by cellophane wrapped choices from convenience stores, gas stations and liquor stores. There is strong evidence that ensuring people have access to healthy food can significantly lower health care utilization and costs. 

Housing plays a large role in health, too. “Those living in poor conditions or facing housing insecurity, relocating from one temporary environment to another, are usually under chronic psychological stress,” Dr. Dews says, “and people who are subjected to these types of living conditions can develop or delay treatment of chronic medical conditions. Treating chronic conditions at a later stage can result in more complicated care and higher costs.” There is strong evidence that providing people who are homeless, or at risk of becoming homeless, with supportive housing can significantly lower expensive forms of heath care, thereby reducing costs.

“There has always been a clear ethical and moral case for addressing social determinants, however highlighting the business case is important in order to get broader buy in and more permanent funding,” Dr. Dews notes. In fact, there’s a growing body of evidence that demonstrates the positive impact of addressing social determinants on health outcomes and use of resources. 

“There’s been studies that look at the impact of providing housing to the elderly,” he says. “It was demonstrated that in addition to reductions in hospitalization and emergency room visits, there were also decreases in nursing home and long-term care facility admissions.”

This creates savings for Medicare and Medicaid, he adds. Home-delivered, medically-tailored meals have been found to lower inpatient hospital admissions, as well as 30-day readmissions. In addition, providing transportation to non-emergent doctor’s visits has been shown to reduce the cost of care, particularly for the older community. 

In order to improve personal health outcomes related to social determinants, Dr. Dews says individual decisions matter, such as quitting smoking, limiting alcohol consumption and even who you hang out with. It is also veryimportant for people to establish a “therapeutic relationship” with a physician. 

Although it may seem difficult, get involved in society. “You have to participate in society to affect social determinants of health.” Educate yourself and become locally politically active so you can affect the policies that impact your environment, he adds.  

Get more health information and find a doctor near you by visiting ascension.org/michigan or calling 866-501-DOCS (3627).

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