Social Determinants: Working Upstream to Solve Health Problems Before They Start

Abstract

Until recently, US health providers have paid little attention to patients after they leave their facility doors. In a way, it’s as though for decades, starting long before the Affordable Care Act (ACA) was enacted, Americans have been part of a separate, long-term, large-scale social experiment, one that’s showing us the impacts of healthcare administered in isolation. But common sense tells us that health is intrinsically linked with the rest of our lives, and research tells us that most of our nation’s health is determined by factors beyond the walls of a healthcare facility. These factors are called social determinants, and they affect health in three primary ways: through access to insurance coverage, access to healthcare services, and by affecting health outcomes directly. The best way to make an impact on health is to figure out which strands of the web to pull and how to pull them. Thoughtful interventions can create ripple effects that eventually lead to better health outcomes and have the added benefit of improving other aspects of lives.