The 12 Social Factors of Health: Why Health Plans Should Care

As healthcare evolves, so does the understanding of what affects a person’s health. While medical care is essential, social determinants of health (SDOH), such as economic stability, education, and access to healthcare, play a pivotal role in determining health outcomes. 

With the growing emphasis on value-based care, addressing SDOH is becoming a key strategy for health plans seeking to improve care and lower costs. 

What Are Social Determinants of Health (SDOH)?

Social determinants of health refer to the broader factors that influence an individual’s health outside of traditional medical care. These are factors such as:

• Food insecurity
• Transportation
• Access to care

Traditionally, healthcare providers have focused on treating illnesses, however, there’s a growing recognition that social determinants play an equally important role in health outcomes.

As the healthcare industry adopts value-based care models, addressing social determinants of health has become crucial for enhancing patient outcomes and reducing healthcare costs.

By addressing these factors, health plans can improve their quality of care while enhancing the patient experience.

A Closer Look at the 12 Social Determinants of Health

Social determinants of health shape the overall health and well-being of individuals and communities. There are 12 key factors that play a critical role in influencing health outcomes:

Income and Social Protection

Income and social protection are closely linked to an individual’s overall well-being. A steady income allows people to afford necessary healthcare services and maintain a healthy lifestyle. 

For those facing economic hardships, social protection programs, such as government assistance or paid leave, serve as essential support systems. They provide financial assistance and improve health outcomes by alleviating the strain of income instability.

Education

Education plays a key role in health outcomes by improving health literacy. Those with higher education levels tend to make more informed decisions about their health, adhere to treatment plans, and seek preventive care. 

Educated individuals are also more likely to have professions that provide access to healthcare services and other health-related resources.

Unemployment and Job Insecurity

Unemployment and job insecurity are a major source of stress, which can negatively affect both mental and physical health. The stress of financial instability often leads to:

• Anxiety
• Depression
• Mental health challenges

Without stable employment, individuals may lack access to health insurance or affordable healthcare, which can further exacerbate existing health problems.

Working Life Conditions

Challenging work conditions, including long hours, high stress, and poor work-life balance, can contribute to burnout, fatigue, and other chronic health problems. 

Additionally, working in hazardous environments can lead to injuries and diseases that impact overall well-being, making it crucial for health plans to consider work conditions when assessing a member’s health.

Food Insecurity

When individuals lack reliable access to nutritious food, they are more likely to consume unhealthy, processed foods that increase the risk of chronic conditions like diabetes, hypertension, and cardiovascular disease. 

Many Medicare beneficiaries rely on food assistance programs like SNAP, highlighting the connection between food security and health outcomes within this population. Tackling food insecurity can help reduce the prevalence of these preventable health issues. 

Housing, Basic Amenities, and the Environment

Without access to safe and stable housing, an individual’s physical and mental health are at risk. When individuals live in unsafe conditions, such as inadequate housing or areas with environmental hazards, their health can suffer. Exposure to toxins, mold, or unsafe living environments can increase the risk of health issues like asthma, allergies, and mental health challenges.

Early Childhood Development

Early childhood is when foundational health habits begin to take root. Behaviors modeled during this stage, such as brushing teeth, washing hands, getting regular sleep, and making nutritious food choices, can lay the foundation for lifelong well-being. Access to proper nourishment, education, and emotional support can influence long-term routines and health literacy.

Early childhood adversity, such as neglect or trauma, can have long-lasting effects on physical health, mental well-being, and overall development, increasing the risk of chronic conditions later in life.

Social Inclusion and Non-discrimination

Social inclusion and non-discrimination are fundamental to a person’s mental and physical health. When individuals feel accepted and valued within their community, they are more likely to engage in health-promoting behaviors and seek necessary care. 

Discrimination and social exclusion, on the other hand, contribute to mental health challenges, stress, and poor overall health outcomes.

Structural Conflict

The impact of structural conflict on health is often long-lasting and persistent. Those living in regions affected by violence or political instability face higher rates of trauma, stress, and injury. 

These conditions lead to a range of health problems, including:

• Mental health disorders
• Chronic diseases
• Reduced ability to access necessary healthcare services

Access to Affordable Health Services

Access to affordable health services ensures that individuals can receive necessary care, from preventive check-ups to treatments for chronic conditions. 

Without affordable healthcare, individuals may delay or avoid seeking care, which can lead to more severe health problems and higher costs in the long run.

Transportation

Without reliable transportation, individuals may struggle to attend doctors’ appointments, pick up medications, or receive necessary treatments. This barrier is particularly significant in rural or underserved areas, where transportation options are often limited. These residents often face travel distances 20 miles farther for routine services and 40 miles farther for specialized treatments.

A lack of transportation can lead to missed appointments, untreated conditions, and poorer overall health outcomes.

Digital Access

Digital access is a key factor in accessing modern healthcare services, such as telemedicine and health apps. 

Individuals without reliable internet access or digital literacy are at risk of falling behind in managing their health. This is especially true for older adults and low-income populations who may struggle to access vital healthcare resources, contributing to health inequities.

Why These Factors Matter for Health Plans

Addressing social determinants of health presents health plans with a unique opportunity to improve both care quality and cost management. By tackling the root causes of health disparities, health plans can:

• Improve Member Adherence and Engagement: Health plans that address SDOH, such as housing, education, and transportation, can build stronger trust with their members, leading to more active participation in care and improved adherence to treatment plans.
• Enhance Chronic Condition Management: Social factors, such as access to nutritious food and healthcare, significantly influence the management of chronic diseases. By focusing on these factors, health plans can reduce complications and improve long-term health outcomes for individuals with chronic conditions.
• Reduce Emergency Room Overutilization: Addressing preventable factors, such as food insecurity and lack of access to healthcare, helps prevent unnecessary emergency room visits, reduces strain on healthcare resources, and lowers overall costs.
• Close Gaps in Preventive Care: Health plans that identify and address SDOH early can improve access to preventive services, ultimately lowering healthcare costs and improving health outcomes by resolving issues before they worsen.

The Challenge of Capturing SDOH Through Claims and EMR Data Alone

Claims data and EMRs (Electronic Medical Records) are vital for managing medical care, but they don’t provide insight into critical aspects of a patient’s life, like their social and environmental circumstances. 

Without understanding these factors, health plans may miss opportunities to offer more personalized and effective care. Proactive SDOH screenings and human insights are key to gaining a comprehensive understanding of a patient’s health.

How In-Home Assessments Help Identify SDOH-Related Needs

In-home assessments provide a unique opportunity for health plans to identify SDOH-related needs that may not be visible through traditional healthcare visits. Matrix Medical Network’s clinician-led visits offer valuable insights into a patient’s:

• Living conditions
• Access to resources
• Non-medical factors affecting their health

Clinicians can also identify challenges such as food insecurity, unsafe housing, and transportation barriers during these home visits.

The trust built in the home setting often leads to more honest answers, allowing health plans to intervene earlier and better allocate resources where they are most needed.

From Screening to Solutions: Meeting Members Where They Are

Proactively addressing SDOH allows health plans to take action before problems escalate. By focusing on early identification and addressing the root causes of health challenges, health plans can deliver better outcomes, reduce emergency visits, and optimize care delivery. 

Meeting members where they are and providing tailored solutions ensures that both health plans and members benefit from a more effective and responsive healthcare system.