Healthcare / Medicare / Politics

A Call for Social Determinants

It is common knowledge that the United States spends substantially more money on health care than other developed nations, yet it is by no means the healthiest country. Health care accounts for one-sixth of United States’ gross domestic product (GDP), but morbidity continues to rise. Two out of three American adults are obese, one-third of American adults have high blood pressure, and diabetes prevalence is expected to grow by 54 percent in the next 12 years.  A look into the determinants of health helps illustrate why the U.S. is experiencing a larger disease burden despite its higher spending. Experts estimate that medical care accounts for 10 to 20 percent of an individual’s health, and the remaining 80 to 90 percent is attributable to the social determinants of health. Currently, U.S. investments in health care do not align with the main factors impacting health: 88 percent of health expenditures fund medical services. The inattention to the social determinants of health and over-investment in medical treatment has left the U.S. population in a state of poor health status and unaffordable health care.

The social determinants of health encompass the conditions in which people live, learn, work, and age, along with the broader social positions individuals are born into. Poverty, unemployment, and housing insecurity are all examples of social determinants that lead to poor health outcomes. While the health care delivery system impacts health during episodes of injury or illness, the social determinants interact with health much earlier, and on a day-to-day basis. The social determinants are thus predictive of health, and can be used in intervention efforts to prevent disease. A wide range of evidence shows that increased social service investments result in improved health outcomes and health care savings. For example, U.S. states with a higher ratio of social to medical spending experience better health among citizens including lower obesity and type 2 diabetes prevalence, improved mental health, and lower mortality rates for lung cancer. Redirecting funds to social services is an investment that keeps people healthy, lightens the disease burden, and saves health care dollars while avoiding expensive medical care.

Recognition for the role social factors play in health has increased in the economic literature and broader policy conversation in recent years, and this growth is beginning to get legislative attention. The CHRONIC Care Act, included in the Bipartisan Budget Act of 2018, expands benefits covered in certain Medicare Advantage plans to include social services. One example is plans will now cover expenses that increase accessibility in homes, preventing falls and expensive medical care down the road. Similar legislation has been enacted in the past, but never at the federal level. The legislative action is encouraging and shows a shift from the traditional approach the United States has taken to solve health care problems.

The evidence behind social services to improve health and reduce health care costs should guide policymakers to be more proactive about future legislative efforts. The CHRONIC Care Act benefits individuals with chronic conditions, and acts to prevent chronic conditions from worsening. The next step should be to focus on implementing social services earlier to prevent the onset of chronic conditions in the first place. Legislative agendas should expand the role of social services in health care as a more cost-effective means to keep individuals healthy, and costs down.