by Elizabeth Hofheinz, M.P.H., M.Ed., August 16, 2019
Ideas about what exactly determines health and wellness are shifting. New research from the University of California, San Francisco (UCSF) states, “A substantial literature now documents how individuals’ genetic and behavioral risks operate in the context of social, political, and environmental conditions that alter access to resources such as healthy food, safety, financial resources, quality education, and gainful employment— all of which shape health outcomes over the life course.”
Laura Gottlieb, M.D. is associate professor of family and community medicine and director of the Social Interventions Research and Evaluation Network https://sirenetwork.ucsf.edu at UCSF. Along with colleagues, Dr. Gottlieb published, “Social Determinants of Health: What’s a Healthcare System to Do?” in the July-August 2019 edition of the Journal of Healthcare Management. 
Dr. Gottlieb and her colleagues proposed four strategies for healthcare system action on Social Determinants of Health (SDH). The first two strategies involve modifying patient care, including by adapting clinical decision-making in light of information on patients’ social risks and by intervening more directly to reduce patients’ social risks. These two patient care strategies are focused on clinical services or other programs directed toward improving health for specific patient populations—also known as population health management.
The other two strategies influence populations more widely, such as the population living in a county or region—not just patients served by a hospital or health plan. These strategies include financial investments and multisector partnerships.
Asked what sort of clinical-community partnerships she has seen that improve patients’ social and economic circumstances, Dr. Gottlieb told OSN, “Hospitals and health systems have a long history of engaging with community agencies that have expertise and capacity to engage around patients’ social conditions”. She went on to note, “Recently, an increasing number of incentives from federal and state payers has emerged to help formalize some of those relationships. A pending National Academies of Sciences, Engineering, and Medicine report highlights effective partnerships and the incentives that support them.”
“Many hospital administrators are actively exploring how addressing social conditions can help improve patient and population health and simultaneously leverage value-based payment programs and other financial incentives.”
The authors highlight a wide range of relevant approaches, including activities at both point of care and community-levels.
Frank Phillips, M.D., Director of Minimally Invasive Spine Surgery at Rush University Medical Center in Chicago, told OSN –
“This research focusses on social determinants of health and in this context highlights the idea of population health management. With the prevalence of musculoskeletal conditions and the immense burden this places on society, holistic approaches to these disease states are warranted. The effect of societal, socio-economic and work-place dynamics are well known to affect patients perceptions of their musculoskeletal condition as well as their likelihood of receiving various treatment options. Low back pain highlights this paradigm where the causes are multifactorial and these conditions are often managed by varied physicians with disparate training and treatment philosophies often leading to excessive, expensive and unnecessary treatments. The idea of population management of this cohort of patients taking into account societal factors has been suggested as a more rational approach to providing value based care.”