Bold action needed on social determinants to improve health outcomes
26 September 2019
We know that the social, economic and environmental factors of where we live and work, such as social isolation, economic inequality, pollution and poor food can greatly influence an individual's health. Yet the vast proportion of health spending is focused on curative measures and working in organisational silos. The Long Term Plan makes clear the need to focus on health inequalities and tackle the wider determinants of health. The very development and objectives of Integrated Care Systems, Local Health Boards, Health and Social Care Trusts and Integrated Joint Boards is to address the health needs of local populations and deliver person centred and coordinated care, crucial to tackling health inequalities. However our research shows that 52% of people said they have not discussed any social, economic, behavioural and environmental factors with any healthcare provider or professional.
Our report, Action required: The urgency of addressing social determinants of health, suggests ways for healthcare systems and governments to target social determinants of health by intervening earlier to prevent or stall the progress of chronic disease, especially when it comes to obesity and diabetes. It proposes five steps for bold action:
- Build the collective will - too many healthcare stakeholders aren’t talking about social determinants - a convener can help bring partners together across the system by demonstrating the long-term benefits to each stakeholder of preventing more illness.
- Develop a framework that enables partners to work toward common goals - partners must overcome the everyday challenges of merging disparate workplaces with different missions, incentives and perspectives.
- Generate data insights to inform decision making - predictive analytics can be used to consider both individual behaviour and the behaviour of populations.
- Engage and reflect the community - social determinants of health strategies must be grounded in the way people live and work. Retailers, technology providers, home health workers and educators could provide new pathways to engage with consumers.
- Measure and redeploy - review, report and plan ahead to further refine strategy and investments.
There is wide recognition of what constitutes social determinants of health in the UK and that action is needed. There have been some successes with a number of innovative initiatives and partnerships across the country at a local level and partnerships across the health and social care sector and the voluntary sector. But progress overall has been limited and patchy and not implemented at scale due to the differences that remain between the NHS, and other institutions in terms of funding, governance and accountability. It is critical that leaders better consider the impact of social determinants - innovative medical treatments are rendered ineffective if people don’t have social support and access to resources readily available to help keep them well. By investing earlier in social determinants strategies that help people with housing, exercise, mental health support and ability to afford medications, governments and health systems stand to save money in the long term and improve health outcomes.
This is not a choice - we can’t afford not to act.