pedestrian bridge According toPCW, 80 percent of the responsibility for health outcomes lies inpatient behaviors, one's physical environment and socioeconomicconditions. (Photo: Shutterstock)


Can nations like the U.S. solve the puzzle of why the health ofits people worsens even as it spends more per capita than most countries onhealth care? A recently released report by PwC's Health ResearchInstitute says the two trends can be reversed. But there's a catch:It will not happen without a strategic plan that envisions bringingtogether partners from sectors that have not worked in acoordinated fashion in the past.


The report–Social Determinants of Health–lays out thechallenge ahead for those who would truly reform and restructurethe composition and delivery of the health care system. The reportis based on an ominous premise: that clinical care is responsiblefor 20 percent of personal health, while 80 percent of theresponsibility lies in patient behaviors, one's physicalenvironment and socioeconomic conditions.


Related: Social determinants of health playing a bigger rolein doctor visits


The institute's findings are based on surveys earlier this yearwith 8,000 consumers worldwide, as well as interviews with leadersin various health sectors. One question for consumers elicitedparticularly insightful responses. When asked what was standing intheir way of a healthier lifestyle, 35 percent identified "lack ofsleep" as the number one cause. The second major factor: too muchtechnology. The third: lack of motivation to improve my health.Those types of roadblocks to better health cannot be addressedthrough traditional medical means.


Thus our highly advanced medical system can only do so much."The social determinants of health — often-ignored social factorssuch as employment; housing; income inequality; and level of accessto clean water, education and transportation — undermine progressand can swamp the health systems that ignore them," the reportstates. "Because even the most advanced medical interventions arerendered ineffective when people struggle with social isolation,income inequality, poor nutrition and pollution. As social factorscounteract medical best practices, health systems often remainfocussed on creating solutions at the wrong interaction point:after people are already sick and in crisis."


The report recommends an ambitious five-step strategic responseto the social determinants that offset the billions spent on healthcare "solutions."

Step 1. Build the collective will

The institute understands that addressing personal and socialfactors in health cannot be achieved without bringing togetherparticipants that generally do not have a unified focus. But, thereport says, the accelerating cost of social determinants paid byall parties should compel them to coordinate their efforts."Ownership and responsibility are clear when true costs areunderstood. It will take a coalition of partners who may need tostretch their roles, but leaders must find ways to show prospectivepartners how their goals meaningfully align. Constructing the rightcoalition also will require looking beyond the sector andtraditional partners to consider the community groups, governmentagencies, universities, retailers, technology companies and newentrants that might contribute."

Step 2. Develop standard but adaptable frameworks

This is all about setting mutually agreed-upon objectives andcreating systems to seamlessly connect those involved in theprocess. "Coalition partners should adopt a common framework toclear obstacles and fast-track efforts to work together," thereport says. "Once they have done the hard work of buildingcoalitions, partners must overcome the everyday challenges ofmerging disparate workplaces with different missions, incentivesand perspectives. Coalition leaders must be sure all partners areinvested in, and agree on, the common purpose. … The leaders shouldbe clear about how members will achieve change, and the goalsshould demonstrate how the alignment of the partners' work benefitseach player."

Step 3. Generate data insights to inform decision making

Big Data will play a significant role in establishing thecooperative framework, defining goals, and measuring progress."Data analytics can guide your plan," the report says. "Selectingthe programme investments most likely to spark health improvementcan seem a mysterious endeavour. But leaders are finding thatpredictive analytics can illuminate areas to target that will meanless time and money wasted chasing ineffective interventions."Partners should collaborate to not only share data, but to seek newdata resources to further inform the strategy. "Organisationsshould simultaneously be improving data collection involving socialdeterminants of health, using opportunities such as the adoption ofnew electronic medical record systems or upgrades to data systemsto expand the categories of data collected. … These strategiesallow organisations to look at forecasts for how populations willrespond in the first year, ten years down the line and over theirlifetime, and to further quantify the impact of these investments,even prior to making financial commitments."

Step 4. Engage and reflect the community

This step is all about grounding the collaboration in the realworld. "Social determinants of health programmes must be groundedin the reality of how people live and work. … The success of anysocial determinant of health strategy ultimately depends on thetargeted community's response. Those carrying out the interventionmust have the credibility and knowledge to work in the area so theycan build trust in the population. … Partners should consider theconversations that these frontline workers will have and how theywill be viewed in the community, whether it is with suspicion orrespect. Systems and policymakers need to be mindful not only ofcultural differences, but also of geographic disparities inresources seen between states and regions."

Step 5. Measure and redeploy

The institute advises that the path forward will beunpredictable, and the strategy will require constant fine-tuningsand even sharp turns, based on the metrics selected to guide it."Partners must use evidence to fine-tune and grow socialdeterminants of health efforts and to keep partners accountable. …Successful social determinants of health intervention campaigns areexercises in continual improvement, in which experience, data andinsights are gathered and fed back into the system. Feedbackenables the development of improved strategies and shows wherepartners need to build better social determinants of healthcapabilities or strengthen processes. … As organizations usemetrics to reveal gaps in business capabilities, they also need tobuild in accountability, such as incorporating expectations forinternal leadership, making sure to address needs of coalitionmembers and building social determinants considerations intocontracts."


The report emphasizes that the strategy it has proposed willtake years to deliver on the promise of better health for moreindividuals at a lower cost. The partners must be willing to committo a long-term strategy; otherwise it will ultimately fail. But theeffort must be made. "Pursuing this path is no longer optional; allplayers must act, or risk being swept under by the rising rates ofillness."


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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.