How are healthcare institutions accessing and leveraging the social determinants of health when responding to COVID-19?

SDOH Frameworks

The COVID-19 pandemic has drawn attention to the health disparities faced by low-income and minority communities which are largely caused by social, community, and environmental factors. The Social Determinants of Health(SDOH) are defined by the Kaiser Family Foundation as the “conditions in which people are born, grow, live, work and age that shape health.” HHS’ Healthy People program has also developed an SDOH framework with the goal of creating social and physical environments that promote good health for all. 

Healthy People 2020's SDOH Framework
Healthy People 2020
Kaiser Family Foundation's SDOH Framework
Kaiser Family Foundation          

Research on the SDOH is a growing area of focus in the healthcare industry, since it promises to improve healthcare for underserved populations and help control costs. Doctors and researchers have noted that a person’s ZIP Code is as important as their genetic code in predicting health risks. Please visit the SDOH page on the website for a deeper overview of this topic.

The SDOH for Predictive Analytics

SDOH data can catalyze predictive analytics through improved location-based data about at-risk communities. This data can be collected directly from a patient in a clinical setting and used in combination with an individual’s EHR to better understand the possible risks they face. It can also be collected at the population level from sources including federal, state, and local government agencies. Population-level SDOH data can be leveraged to develop an understanding of risks shared by groups of individuals in the same community or who share other characteristics.

Healthcare providers are finding new ways to connect their patients with resources and assistance outside of a clinical setting. Payers are building capacity for local groups addressing health challenges by providing grants to programs carrying out innovative work, and establishing partnerships with groups that have access to valuable SDOH data. Lastly, many healthcare providers and payers now have dedicated groups or offices specifically focused on building capacity and relationships in their local communities. 

Public health departments function as resource hubs that can provide information and visualizations of key SDOH data. Local health departments also work closely with Medicaid recipients and other underserved populations that may benefit from access to services. Public health departments can partner with other research institutions and private sector companies to better visualize key SDOH data. 

The U.S. government and other public sources can provide much of the SDOH data that is relevant to COVID-19. The U.S. Census Bureau, for example, collects and publishes a wealth of data about America’s changing population, housing, and workforce. The American Community Survey (ACS) collects data on a number of SDOH factors at the ZIP Code and census-tract levels, making it usable for localized analysis. Some of these sources for SDOH data are shown in the table below.

 

SDOH Category Potential linkages to COVID-19 Sample data sources
Economic Stability Most workers receive health insurance through their jobs, but due to increasing rates of unemployment, people are losing their coverage. Only 11% of the employed lack health insurance, compared to roughly 30% of unemployed individuals.  Positive rates of COVID-19 and risk of severe infection are increased among low-income individuals as well.
  • Department of Labor — Unemployment Statistics
  • Internal Revenue Service (IRS) —  Income Tax Statistics
Neighborhood and Physical Environment Homelessness falls under this category and can be a predicting factor of COVID-19 infection. People who are homeless or have unstable living situations have a harder time social distancing, increasing their risk of contracting the virus. Additionally, communities with higher rates of homelessness, inadequate food access, poor environments, and other negative risk factors are predominantly black or minority populated.
Education The health and economic consequences of the pandemic for those with only a high school education or some college are much higher than for those with a bachelor’s degree or higher. The economic stress of unemployment can increase an individual’s overall risk of illness. Low health literacy can also impact one’s ability to access and utilize the latest scientific information and guidance on COVID-19. 
Food The pandemic has affected food supply chains at global, national, and local levels. This in turn is raising the number of people facing food insecurity in the U.S., which is a general risk factor for illness. There is also an increasing number of Americans on the Supplemental Nutrition Assistance Programs due to the pandemic.
Climate and Environment 

 

 There is a link between air pollution exposure and higher COVID-19 cases and deaths. Researchers have shown that long-term exposure to pollutants, including nitrogen dioxide and sulphur dioxide, can reduce the functionality of lungs and increase susceptibility to respiratory illness. Such pollutants have shown to increase the risk of infection by viruses including COVID-19. Long-term exposure or childhood exposure to air pollution and asthma is also a risk factor for more severe and fatal illness.

 

These and other data sources can help fuel new analyses of the link between SDOH and COVID-19.  A number of companies in the healthcare space are now using COVID-19 case data together with SDOH data to predict the risk that certain individuals will be severely affected by COVID-19.