The known social determinants all flow into each other: poor education, lower wages, manual labor, low or no access to quality health care, little to no knowledge and time available for preventative care measures. (Photo: Shutterstock)
The COVID-19 outbreak has not affected all Americans equally. A person's risk of contracting the virus, as well as the severity and likelihood of recovering, are a matter of geographic location, age, ethnicity and underlying health conditions, among other factors. "Essential workers," for example, often correlates to low-wage workers who can't afford to take time off of work to reduce the risk of exposure.
These factors are examples of social determinants of health. In recent years, health care providers and industry experts have been pushing to include these lifestyle factors into health care planning. Employers, as well, have been urged to incorporate such considerations into their health and wellness programs.
Related: COVID-19 and social determinants of health: Considerations for employers
Eric Zerneke, chief commercial officer at CredSimple recently shared some thoughts with BenefitsPRO about how the pandemic is driving awareness of social determinants of health.
How is COVID-19 heightening the impact of social determinants on overall health, both in the short-term and long-term?
This is far more acute than it was prior to COVID-19, or rather, it was more hidden and slower to show the effects — COVID has brought this to the forefront in a very short amount of time. In the short term, those with lower income and less access to quality health care are disproportionately negatively impacted by COVID. They are still working because they cannot afford to distance themselves, and many times their work is in tight quarters (think meatpacking and factories) for low wages and no benefits. In the longer term, those that have been infected but survived may (according to many early medical reports) have lasting issues.
Without proper health care and regular evaluations and support, these individuals are susceptible to chronic care issues as they age.
What are some social determinants of health challenges that exist today?
The known social determinants all flow into each other: poor education, lower wages, manual labor, low or no access to quality health care, little to no knowledge and time available for preventative care measures, inability to purchase and cook higher quality food, lack of exercise beyond manual labor work, and more. These all lead to a systemic issue that perpetuates itself and you see generations unable to get out of poverty, are underserved and suffer from shorter life spans and lower quality of life (chronic disease is more rampant – diabetes, asthma, COPD, etc.)
Why is it important for health plans to shift their models to cater to those with less economic privilege and who lack access to high-quality care/testing? What ways can health plans do this?
If a plan has members in government-based programs such as Managed Medicaid or Medicare, or they are duals or are in CHIP programs, they are all susceptible to these issues of poverty and lower-income generated issues, chronic diseases, inability or unknowingly able to help themselves and their families, etc.
Plans, especially those in Medicaid, are shifting significantly to help their members in various ways beginning with: in-home services, food delivery and food access services such as partnering with communities and local food banks to make sure food is available, services dedicated to checking in on home/living situations to ensure safety (no mold, no gas leaks, running clean water, heat, no pests, etc.), basic clothing needs, access to electronics such as a tablet, simple mobile phone and in-house technologies to help manage their care, daily care management check-ins (have they taken their medication, have they walked today, are they talking with anyone, etc.).
Finally, mental and behavioral health, which is a very large issue today (are they feeling okay, are they communicating, are they lonely, etc.)
What should health plans focus on in order to keep those that are deferring care engaged in the system?
Engagement in the community is the number one priority. Family, faith-based organizations, community centers, groups and organizations, all play a tremendous role. health care is always local. You have to reach people and get them engaged with those around them that they know and trust. It is also important to provide easier methods of access such as in-home visits and transportation services, as examples.
Food insecurity and food deserts have heightened as a result of the pandemic. How do you see these factors driving health coverage in the future?
With millions of children and families unable to access basic needs such as food, heat, running water, etc., this is a primary concern. If we do not solve the foundational problems, the downstream issues will always remain and they will be more challenging.
Anything else to add?
Social determinants are a very large part of what drives issues in health care. Mental/behavioral health is another and is related. If we can address these two areas more effectively, we can significantly improve the downstream impact on health care for individuals and for the country.
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Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
