What are social determinants of health?
Widespread scientific evidence has identified a strong relationship between health and social factors. Social factors make up the conditions, environments and settings that impact overall quality of life. Wilkinson and Marmot (2003) labelled social factors that affect health outcomes ‘social determinants of health.’
“The environments in which we are born, grow, live, work and age can have stronger influences on our health than our genetic family history or behavioural risk factors.” - ACI
Social determinants of health can either strengthen or undermine individual and community health. They often extend inwardly to affect health behaviours and biomedical considerations that are part of a person’s individual lifestyle and genetic make-up.
Social determinants of health include:
- conditions of employment
- residential environment
- social capital
- social exclusion
- early life
Why is addressing social determinants of health important?
In 2016, the Australian Institute of Health and Welfare found that people living in the lowest socioeconomic areas compared to the highest socioeconomic areas were:
- 1.6 times as likely to have at least 2 chronic conditions
- likely to live 3 years less on average
- 30% more likely to have a low birthweight baby
- 3.6 times as likely to be exposed to tobacco smoke inside the home (children)
- likely to spend less on medical and health care
- twice as likely to delay seeing or not see a dental professional
They also found that:
- a higher proportion of people with an employment restriction due to a disability lived in the lowest socioeconomic areas (26%) than in the highest socioeconomic areas (12%)
- unemployed people were 1.6 times as likely to use cannabis, 2.4 times as likely to use meth/amphetamines and 1.8 times as likely to use ecstasy as employed people
- if all Australians had the same death rates as people living in the highest socioeconomic areas, overall mortality rates would be reduced by 13% (54,000 fewer deaths)
- people reporting the worst mental and physical health were twice as likely to live in a poor-quality or overcrowded dwelling
One study (Brown et al. 2012) had suggested that if the health gap between the most and least disadvantaged were closed Australia could be spared:
- $2.3 billion in annual hospital costs and;
- $5.3 million in Pharmaceutical Benefits Scheme prescriptions
The World Health Organisation has made recommendations on what is required to close the health gap through action on social determinants, which include adopting a whole of government approach with policies and interventions from all sectors and levels of society. In Australia specifically, a major focus has been on closing the gap in Indigenous health.
Despite a push towards tackling health inequalities, the complicated relationship between social determinates continues to challenge conventional policy. Current researching is focusing on better understanding the causal links between social determinants of health outcomes, as well as which policy areas might lead to better health outcomes. These policy areas include:
- monitoring and evaluation
- data availability
- extension of reporting on socioeconomic variables
- health and welfare linkage
- additional longitudinal data additional longitudinal data
Addressing social disparities using integrated care
The aging population and the changing burden of disease, especially the increased prevalence of long-term conditions, requires coordinated care between health and social care. Equitable access to traditional health and care services plays an important part in determining the health of the individual and the population. A focus on social determinants of health is critical for health equity, especially for vulnerable populations who face health disparities and inequalities.
Integrated Care NSW is continuously working to establish policies that address social determinants of health by positively influencing social and economic conditions and supporting changes in individual behaviour. These policies aim to improve health outcomes for vulnerable populations over time.
The current integrated care scaled initiatives focus on improving the health outcomes of the more vulnerable in our communities. They focus on addressing social determinants of health in these communities, in order to close the health gap between subsectors of our community. These initiatives address various social determinants in the following ways:
|Residential Aged Care
||Improving outcomes for people living in Residential Aged Care Facilities (RACF) during periods of illness
||Through enabling people to be cared for at their place of residence, where appropriate, rather than unnecessary transfer to hospital, patients experience enhanced health outcomes|
|Emergency Department to Community
||Providing an intensive case management approach for people who present to a hospital’s Emergency Department ten times or more in a twelve-month period
By identifying and addressing the needs of people likely to have multiple complex and chronic care needs
|Specialist Outreach to Primary Care
||Optimising patient care in the community through collaboration between primary care and secondary care clinicians
||By including identified patients in a structured care coordination program to enable appropriate care if they attend hospital, and while in the community|
||Enabling children with complex needs to receive care closer to home where possible and appropriate, while also receiving specialist care where required
Through upskilling local services and enablers such a telehealth, children and families can reduce travel time and receive coordinated care
||Providing intensive care coordination intervention for families where the parents or carers have complex health and social needs, and who have at least one child unborn to 17 years of age
||By addressing the barriers to engagement with the health system and other social services (including education and family and community services) that this cohort is likely to experience. |
|Planned Care for Better Health||Identifying patients at risk of hospitalisation early, strengthening the care provided to them, improving their experience of receiving care and keeping them healthier over the long term. ||By focusing on proactive preventative healthcare, and reducing instances of hospitalisation. Planned Care for Better Health builds on the Integrated Care for People with Chronic Conditions program with the introduction of an improved algorithm to enhance identification of at-risk patients |
|Secondary Triage||Provides an alternate pathway for low acuity RACF calls to NSW Ambulance. ||Through clinical management support provided by the MyEmergencyDoctor Service, staffed by Fellow of the Australasian College for Emergency Medicine Specialists (FACEMs).|
Information on a broader selection of NSW integrated care initiatives with a social determinants of health focus can be found on the Agency for Clinical Innovation website.
Risk of Hospitalisation Algorithm and social determinants of health
The Risk of Hospitalisation Algorithm presents a meaningful prediction of a patient’s unplanned hospitalisation events in the twelve months following their initial admission. It is based on an extensive list of demographic and socioeconomic factors as well as hospitalisation and medical history. The Risk of Hospitalisation Algorithm covers a wide range of chronic conditions and identifies which patients are likely to benefit from integrated care interventions.
The NSW Integrated Care Team is currently working with NSW Local Health Districts, Specialty Health Networks and Primary Health Networks to collect data using the Risk of Hospitalisation Algorithm. This data is then extracted, shared and used to create transformation plans, fact sheets, monitoring and evaluation toolkits, program logics, evaluation questions and data plans. The data and tools it inspires create the foundation for the policies and initiatives currently being developed.