| A parable used in public health goes, if there is a group of people who’ve fallen into a river that need saving, the traditional treatment method would be to rescue them from drowning downstream. However, going upstream to find the cause of why these people were falling into the river in the first place would follow the preventative method. The story is used to illustrate how addressing social determinants of health (SDOH) and preventing people from getting sick can be a more effective strategy than simply treating them afterward. Recently, this idea has been thrust into focus as the coronavirus continues to impact virtually every aspect of life. In fact, during the pandemic, Black, Native American Indian, and Latinx communities faced the highest rates of severe illness, according to the CDC. Socioeconomic status also played a role in risk factors. A study by the Kaiser Family Foundation found that adults at risk of serious illness if infected with the virus was highest among those with a household income of less than $15,000 a year. “COVID-19 has shed a light on disparities in general, especially racial disparities,” Rene Cabral-Daniels, the CEO of Cenevia, told MobiHealthNews. “I do think that if we’re going to be serious, if we’re really going to make a difference, we’ve got to be impactful and meaningful in terms of anything we do with social determinants of health.” The government’s health initiative known as Healthy People 2020 lists factors like economic stability, education, social and community context, healthcare, and environment as key areas of SDOH. The idea that these determinants affect people’s health outcomes predates COVID-19. One of the earliest studies on the issue took place over a century ago and examined the relationship between housing, nutrition and economic level during pregnancy and infant mortality. However, despite the fact that genetics and clinical care amount to only 30% of a person’s overall health, a survey from Welltok found that people overestimate the role that it plays in their health, believing that it accounts for 49% of how healthy they are. Knowing that social factors can play a major role in a population’s health, many organizations have been trying to address SDOH for years. Most programs are created to help their communities reach a place of health equity, which is defined by the CDC as “when everyone has the opportunity to ‘attain their full health potential’ and no one is ‘disadvantaged from achieving this potential because of their social position or other socially determined circumstance.’” Despite the effort, health disparities do exist, and one of the biggest disparities comes from racial and ethnic differences. In the U.S., health disparities related to race take on many forms, including higher rates of chronic disease and premature death compared to whites. In 2010, African Americans were 30% more likely to die prematurely from heart disease, and African American men were twice as likely to die prematurely from stroke compared to their white counterparts, according to the National Center for Biotechnology Information. In 2017, American Indian and Alaska Native adults were almost three times more likely to have diabetes than non-Hispanic white adults. They were also 2.5 times more likely to die from diabetes, according to the U.S. Department of Health and Human Services Office of Minority Health. In 2018, Hispanic Americans were 1.2 times more likely to be obese than non-Hispanic whites, according to the OMH. Organizations addressing SDOH pre-pandemic One such company that has been focusing on SDOH is NowPow, a community-based organization-referral company. “Our approach is a whole-person approach,” Dr. Stacy Lindau, the founder of NowPow, told MobiHealthNews. “We’ve developed a technology solution that envisions that all people do better if we are all connected to the resources of our communities. Our solution recognizes that most of health happens outside the doctor’s office. It happens outside the four walls of the hospital or the medical center.” NowPow’s platform works by connecting health systems, health providers and health plans to community resources in their area that they can refer to patients. With over 200 different types of services available on its platform, NowPow can address a variety of needs, according to Rachel Kohler, the CEO of NowPow. “The biggest need, usually, across our customers, is food,” she said. “We’re also moving into areas that support social isolation, a lot of cancer support groups [and] any services related to diabetes or hypertension, depression. We have a large mental health set of services in our taxonomies. But then, we also support unemployment services, whether it’s job training or job-search assistance.” ChristianaCare has a similar platform for connecting people with resources in their community. The system gathers data on a patient and can then recommend them to a service targeted specifically to their needs, according to Dr. Janice Nevin, the president and CEO of ChristianaCare. “We have a data platform that gets real-time data that then uses AI [artificial intelligence] and ML [machine learning] to create that patient story,” Nevin said during the 2019 Annual Thought Leadership on Access Symposium. “It feeds to a data analytics engine, and we have risk-score set so we can decide what level of risk you want to set. So, in real-time, our virtual care team is getting information from our patients.” The health system has connected its patients to a wide variety of services, including those of behavioral health specialists, nutritionists, diabetes managers and social workers. “We even had loneliness counselors; we had volunteers come and talk to people who are lonely,” Nevin said. The impact of COVID-19 on health disparities During the pandemic, these disparities were only made more apparent. “Long-standing systemic health and social inequities have put some members of racial and ethnic minority groups at increased risk of getting COVID-19 or experiencing severe illness, regardless of age,” the CDC said on its website. As of June 12, the age-adjusted hospitalization rates were highest among non-Hispanic American Indian or Alaska Native and non-Hispanic black persons and followed by Hispanic or Latino persons, the CDC reported. In the age of COVID-19, NowPow had to adjust its services for customers located in the heart of the pandemic. Some of its largest networks were in New York, New Jersey and Illinois. “We were in the thick of it, and we immediately, because we’re supporting these larger organizations, understood the magnitude of what was happening,” Kohler said. As a result, NowPow began integrating “COVID status tags” in the platform to keep users up to date on what was opening and in what capacity. “As you can imagine, that’s a huge challenge because what’s open and operating is changing daily,” Lindau said. “It is hard to know, even if you’re a knowledgeable person in your own community what’s open and operating.” The company also created a rapid sign-on system where a link could be sent out by text to a potential user to immediately get them registered on the platform. Through that rapid sign-on, emergency services that were popping up in the areas covered by NowPow could get added to the registry. “NowPow has made it our business to know more than 45,000 community and emergency-relief services which are open and operating,” Lindau said. “So when we send people to places – people who have a real need and who find it hard to get to places under the current circumstances – those [services] are there to help them.” Other companies, like Unite Us, which was featured in a recent HIMSS20 Digital session, have also been addressing SDOH during the pandemic.
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