Social Determinants of Health and their Impact on COVID-19

As our healthcare system shifts toward value-based models that reward positive outcomes rather than individual procedures and treatments, healthcare leaders increasingly see social determinants of health (SDOH) as critical components of these efforts. According to the WHO, Social determinants of health are defined as the non-medical factors that influence health outcomes. They are the circumstances in which people are born, grow, work, live, age, and the larger set of factors and processes that affect daily life situations. Economic policies and systems, development agendas, social norms, and political systems are examples of these forces and systems. The organization further states that the social determinants of health significantly impact health inequities, which are inequitable and avoidable differences in health status seen within and between countries. Health and illness follow a social gradient in countries of all income levels: the lower the socioeconomic position, the worse the health. 

What are the Different Types of Social Determinants of Health?

Social determinants of health may be more influential than health care or lifestyle choices in influencing health. Numerous studies suggest that social determinants of health account for between 30% to 55% of health outcomes. Furthermore, estimates show that the contribution of sectors other than health to population health outcomes exceeds the contribution of the health sector. Addressing SDOH appropriately is critical for improving health and reducing long standing health inequities, requiring action from all sectors and civil society. The SDOH are a subset of health determinants. Important health determinants include government policies, healthcare availability, individual behavioural choices, and biological and genetic factors. Some social determinants of health examples are:

Why are Social Determinants of Health Important?

The social determinants of health are one of the most crucial aspects of health, which aims to achieve health equity. Health equity is defined as “everyone having the opportunity to ‘achieve their maximum health potential,’ with no one being prevented from doing so because of their social status or other socially determined circumstance.” Poverty, unequal access to health care, a lack of education, stigma, and racism are all underlying contributing factors to health inequities. Health organisations, institutions, and educational programmes are encouraged to look beyond behavioural factors and address underlying social determinants of health.

If people have access to essential socioeconomic opportunities such as food security, toxin-free environments, better employment and education opportunities, and so on, their health automatically improves and the likelihood of needing expensive medical services in the future decreases. The SDOH improves health equity by focusing on all levels of governance, from local to national. SDOH lays the groundwork for a society that values social, emotional, and cultural well-being.

Social Determinants of Health Screening Tools

Many Transforming Complex Care sites adapted existing or developed new social determinants of health assessment tools to capture better patients’ social needs and barriers to care. The three commonly used social determinants of health screening tools are: 

1. The PRAPARE tool created by the National Association of Community Health Centers comprises 15 core questions and 5 additional questions for responding to and assessing patients’ assets, risks, and experiences. As structured data, the data can be directly uploaded into many electronic health records. Clinical or non-clinical workers usually deliver it; however, a paper version might be supplied to the patient to self-administer.
2. As part of The EveryONE Project, the American Academy of Family Physicians provides social determinants of health screening tools in both short and long-form English and Spanish. It can be administered by clinical or non-clinical staff or self-administered. There are 11 questions in the short form.
3. The 10-question Health-Related Social Needs Screening Tool (AHC-HRSN) developed by the Centers for Medicare & Medicaid Services Accountable Health Communities is designed to be self-administered.

Social Determinants of Health and COVID-19

The social determinants of health such as poverty, the physical environment, and race or ethnicity had significantly impacted how COVID-19 infection has spread and its outcomes. For instance, homeless families have been at higher risk of viral transmission because of congested living areas and limited access to COVID-19 screening and testing facilities. Physical distancing measures, required to prevent the spread of COVID-19, are significantly more difficult to achieve for those with negative social factors and may contribute to both short- and long-term morbidity. School closures exacerbated food insecurity for low-income children who relied on school lunch programmes. Malnutrition put young children’s physical and mental health in danger and reduced their immune responses, which raised the likelihood of infectious disease transmission. Homeless people and families were more affected during physical lockdowns, especially when public venues were restricted, resulting in physical congestion, which then promoted viral transmission and reduced access to care. The ability to physically separate oneself has been labelled a privilege that is just not available in some cultures or social groups. The link between social inequalities and COVID-19 morbidity was further exacerbated with underlying chronic respiratory disorders like asthma, which had an additive or even exponential level of influence on COVID-19 morbidity. Poverty, cigarette exposure, and race or ethnicity, all raised COVID-19 morbidity. Thus, the influence of social determinants of health on COVID-19 morbidity may be underappreciated. However, the tremendous public health lesson learnt is that pandemics have disproportionately affected the poor and underprivileged for millennia.

The five domains of social determinants of health, i.e., education, healthcare, neighbourhood, economic stability, and social and community context, are interconnected and had critical roles during the COVID-19 pandemic. For example, an individual’s education level can influence their occupation, which determines economic stability and income level, which can affect the type of healthcare the individual is eligible for and what neighbourhood the individual lives in, which then influences the social and community context the individual is surrounded by, and all of these factors played a role in the current COVID-19 pandemic.

Although the concept of social determinants of health, or health drivers, is not new; there has been a surge of interest across the healthcare value chain, particularly in the wake of the current COVID-19 pandemic. The pandemic revealed glaring inequalities and demonstrated how minority communities are more vulnerable to COVID-19. Because of underlying health concerns, employment as “critical” employees, restricted access to healthcare and insurance, and a greater reliance on public transit, many African American communities are particularly vulnerable. COVID-19 provides a once-in-a-lifetime chance for researchers to gain a deeper understanding of the vulnerabilities of diverse populations and to give a contextualised therapeutic approach. COVID-19 crisis has had a disproportionate impact on vulnerable people, families, and communities. Social determinants of health provide a common language for stakeholders to reach out to their legislators in order to address areas that require change. It is critical that policymakers, researchers, and community leaders develop policies that encourage the meaningful use of social determinants of health.

Role of Pharma in Addressing Social Determinants of Health

Pharmaceutical companies, which have previously addressed social determinants of health (SDOH) through foundation donations to community groups, are now taking new steps to address health inequities, including more direct partnerships with provider groups and payers, as well as initiatives to diversify clinical trials. These initiatives have been inspired in part by the COVID-19 pandemic, which has disproportionately affected impoverished populations.

However, pharmaceutical companies understand that by focusing on SDOH, they may enhance patient access and adherence measurements. Companies such as CVS, Blue Cross of North Carolina, OneCity Health, and others have formed innovative collaborations to solve SDOH issues ranging from transportation obstacles to food insecurity. Furthermore, several key pharmaceutical companies such as Pfizer, Novartis, Johnson & Johnson, Merck, GlaxoSmithKline, Roche, and several others have also joined forces to address food insecurity and promote health equity solutions. Moreover, in today’s world, significant potential exists for healthcare institutions, particularly pharmaceutical companies, to become more involved in SDOH and make a substantial influence on the people they serve. 

What Lies Ahead?

Pandemics are more of a social issue than a healthcare problem. COVID-19 has a disproportionate impact on the population that lives in poverty and overcrowded neighbourhoods with poor maintenance and sanitation. The social determinants of health was overlooked during this pandemic. Poverty, inequalities, and social determinants of health have all been linked to the spread of infectious diseases in the past. Inequalities in health and healthcare can exacerbate morbidity and mortality. Understanding factors that influence health and healthcare, such as SDOH, can help those socioeconomically disadvantaged gain access to medical and non-medical resources. It’s also crucial to educate the public and increase awareness about the problem’s seriousness. COVID-19 outbreaks can be thwarted by appropriate and timely education, health care, and social services.

Integrating social determinants of health into efforts to minimise health and healthcare disparities could be the key to reducing global disease. This can be accomplished by assembling an interdisciplinary team comprised of health care professionals, public health professionals, anthropologists, sociologists, researchers, governments, the NIH, the CDC, the WHO, and others, all of whom can contribute to analysing and understanding the various factors that contribute to health disparities in populations that already face socio ecosystem challenges.

In addition, pharmaceutical companies have a significant effect on SDOH. SDOH affects every stage of a pharmaceutical product’s life cycle, from research and development to product introduction, affecting product growth, maturity, and eventual market decline. Pharmaceutical businesses are well-positioned to detect social risk factors and unmet social requirements and to do their utmost to meet and mitigate such needs.

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