Health care and community-based organization partnerships addressing Social Determinants of Health

Even though nobody likes to speak about it, the fact remains that we live in an uneven society. A society characterized by classes and social gradients. A society where there are disparities on all fronts and humans are categorized as falling in the mid, low, or high class. The result of these social disparities spread into the health sector, leading to a diversity between how people get care, what health conditions people develop, and what the likely outcomes are.

In this guide, we aim to discuss the long-standing issues of Social determinants of health (SDOH), and how – through a coordinated care network between healthcare professionals and social workers – its impacts can be mitigated.

The basics

The World Health Organization defined SDOH “as the conditions in which people born, live, work, age, and grow.” “Conditions which are shaped by the social status of individuals, including societal status, employment status, settlement, and distribution of money, power, and resources at large.”

While all of these socioeconomic factors are long-standing features of the world we live in, we can no longer leave them unaddressed because of how great their impacts are becoming on public health. Take, for instance, the socioeconomic factor "poor housing." When this factor is unaddressed, it could have a direct impact on a patient's health, such as developing respiratory illnesses. Patients living in this unsuitable settlement might develop these respiratory issues at a higher rate, leading to a health disparity.

If the root cause of this problem (poor housing) is, however, addressed, it can save lots of health care costs, and even improve the health outcome of people living within the area. This sentiment is shared by the Healthy People, who claimed in their 2020 reports that addressing the downstream sources of a patient’s condition is key to improving the overall public health.

How healthcare organizations address social health requires a patient engagement rework

If healthcare organizations are really serious about combating the various social factors that impact people’s health (SDOH), then they need to overhaul their current patient engagement systems and adopt a far more immersive approach.

By an immersive approach, we mean extending patient care beyond primarily focusing on diseases and illnesses. But taking the time to screen patients, obtain historical data, and engage them in a manner that makes them feel at home to tell you their true story.

Remember, a patient might come to your establishment complaining about diabetes. They will never tell you whether they have the financial power to live on the diet you’ve suggested to them, or whether they’re financially buoyant to visit the pharmacy and get the prescribed drugs. But when you engage them and make them know about the series of health and social resources that are available to them, it becomes easy to obtain those vital data you need to refer them to the right resources.

How have healthcare organizations been addressing the social determinants of health?

On the hospital level, many organizations connect with community partners to overcome social needs. This outreach usually begins with recognizing some sort of health disparity or community shortfall.

These organizations identify specific needs among their patient populations using community health care management software like C3S to take patients' assessments. Over time, this tool collects vital patients’ data, making it easy for these organizations and their partners to glimpse which social factors are driving health disparities and health inequity within the individual community. With whatever information collected by this app, healthcare providers can then proceed to offer more than just health care to their patients. As they now have the capability to recommend viable social support systems to their patients.

The tool, thanks to its AI-integrated system, also helps hospitals determine which non-profit community service and social service providers have the necessary resources to address the social determinants of health. With this, health officials can easily see what the prevailing SDOH is, which partners are currently capable of rendering assistance, and what criteria are required for a patient to be referred.

According to the AHA, the following steps are crucial to creating a community health partnership between health care providers and potential social services.

• Identify partners and their assets

• Host community collaborative meetings

• Define roles and responsibilities in a collaborative

• Address common goals in a collaborative

• Create an action plan

• Measure partnership effectiveness

• Overcome obstacles

• Celebrate progress

Healthcare organizations that follow these steps ensure that they are creating a scalable plan for community outreach. Creating a common ground between the hospital and community partners will help drive a more permanent change for patients.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes