RISE looks at recent headlines concerning social determinants of health (SDoH), including the impact social distancing has on those already most vulnerable.

The negative impact of social distancing

Social distancing has become a strongly encouraged practice since the World Health Organization upgraded COVID-19 to pandemic status. But the practice also is a risk on the poor and those already at a health disadvantage, writes Erin Paquette, M.D. in an opinion piece published in The Hill.

Although she agrees social distancing is essential, she sheds light on those with restricted mobility and unable to participate, such as those with chronic diseases who require hospital admission, individuals who can’t care for themselves who live in long-term nursing facilities, and those living in publicly-supported housing.

“Public health officials, researchers, and policymakers need to think about populations at greatest risk for disparities and how to protect them. They must track carefully how the virus is impacting groups with restricted mobility in particular,” she writes. “They should support policies to ensure early access to testing and care for these groups, including vaccination and antiviral medications, if available. And, they should think long term about how to reduce the number of people living in restricted settings.”

Study: Patients in rural communities skip preventive healthcare

Patients who live in rural communities are more likely to skip routine cancer screenings and preventive care due to geographic location and SDoH, according to a recent Mayo Clinic study published in JAMA Open Network.

To understand the rates of recommended cancer screenings, researchers looked at medical records from 75 primary care providers in three states with substantial rural populations: Minnesota, Iowa, and Wisconsin. They also used the area of deprivation index (ADI), a measure from the Census Bureau, to evaluate key SDoH and cancer screening rates within the 20 percent most deprived areas within the three states.

The findings showed that patients living in the areas with the highest ADI scores, meaning they experience more SDoH, were about half as likely to receive recommended cancer screenings (0.51 for breast cancer screenings, 0.58 for cervical cancer screenings, and 0.57 for colorectal screenings). The chances of completing a recommended cancer screening was also lower in rural settings (0.76, for cervical cancer it was 0.81, and for colorectal cancer it was 0.93).

“Overall, the results of the present study suggest that implementing area-based measures, such as the ADI, into practice and understanding differential cancer screening practices based on rural status may help inform and guide tailored interventions to meaningfully address disparities based on social determinants of health,” the researchers said.

Hospitals are best positioned to address SDoH but they don’t have the funding

Leading C-suite executives in health care rank hospitals as the best positioned institution to address SDoH and social disparity issues, according to the latest Advis survey. More than 200 health care experts responded to the survey, which included seven questions about their institutions and SDoH issues. Here are the key findings:

  • More than 38 percent ranked their hospital’s positioning within the community as ideal for confronting SDoH issues
  • A little over 28 percent ranked the government best positioned to help
  • Roughly 28 percent ranked social services and philanthropic organizations best positioned to help
  • Only a third of executives report participating in an SDoH program
  • When government and social services rankings are combined, 56 percent of responses suggest that the hospital might not be the place to start when confronting SDoH
  • 85 percent of survey respondents said the lack of direct reimbursement for hospitals was the leading factor the prevented SDoH progress

The SDoH initiatives address areas well beyond the traditional responsibilities of the hospital such as socio-economic status, disability status, homelessness, and location. But the longer the issues go unaddressed, the more they continue to impose problems and financial burden to the hospitals.

Aging at home is ideal but unrealistic to many

A recent study by Fresenius Medical Care North America (FMCNA) indicates that 65 percent of the general population feel “aging in place” is a goal, but only 33 percent think they will actually grow older in their current home. The desire to age at home rather than a community is for comfort, familiarity, independence, and to be near friends and family.

The survey findings indicate that the barriers to aging in place are highly connected to the SDoH that people experience. The top five SDoH barriers to aging in place include:

  1. Financial
  2. Food insecurity
  3. Health literacy
  4. Community
  5. Housing security

Most Americans are currently dealing with at least three types of SDoH (77 percent), and more than a third are affected by six or more types (37 percent). The survey results indicated lower income individuals, African Americans, Hispanic Americans, and people with chronic health conditions are those that are most affected by SDoH. High-income individuals are much less affected.

Despite the goal to age in place, more than half of the general population have not yet considered taking actions to enable them to do so.