Leveraging the Social Determinants of Health: What Works?
We summarized the recently published, peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of healthcare and social services on health outcomes and healthcare spending. Of 39 articles that met criteria for inclusion in the review, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), healthcare costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. Our analysis of the literature indicates that several interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have had positive impact in terms of health improvements or healthcare spending reductions. These interventions may be of interest to healthcare policymakers and practitioners seeking to leverage social services to improve health or reduce costs. Further testing of models that achieve better outcomes at less cost is needed.
Overview of article
- Social determinants of health have taken center stage in recent health policy discussions, particularly with the growing emphasis on global payment, accountable care organizations (ACO) and value-based financing models face substantial challenges in equipping healthcare providers to achieve improvements in the population’s health
- This article aimed to synthesize the existing empirical evidence about the impact of social service interventions on health outcomes and healthcare spending, with particular attention to identifying programs and practices that achieved both improvements in health as well as potential reductions in healthcare spending
Methods of article
- This article summarized the peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of healthcare and social services on health outcomes and healthcare spending. This study used the PubMed database to execute the initial search and included relevant literature published in English between January 2004 and October 2014. This search included a number of search strings comprised of a combination of social and health keywords
- Overall, of the 39 articles, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), healthcare costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. No particular study design, intervention, or population was recurrent among studies with non-significant, mixed, and negative findings
- The studies mainly focused on: 1) Housing support; 2) Nutritional support; 3) Income support; 4) Care coordination and community outreach; and 5) Educational interventions among children
- Overall, of 12 studies evaluating housing intervention, 4 studies reported both improved health outcomes and reduced health care costs. Five additional studies showed improvement in health outcomes including obesity and diabetes among women with children, asthma among adults, self-reported health status among adults, mobility among low income older adults and HIV outcomes
- Of the 11 studies related to nutritional support interventions, 7 studies reported significantly improved health outcomes. No studies reported decreased health care costs associated with nutritional support interventions
- Authors found 4 studies related to income support, all of which demonstrated a positive relationship between income support interventions and health outcomes, or both health outcomes and healthcare costs
- Of the 9 studies reviewed with care coordination and community outreach interventions, 4 showed decreased healthcare costs associated with the intervention. Two other care coordination interventions were shown to have a significantly positive impact on health outcomes, specifically on all-cause mortality in mothers and on birth-weight among African American mothers , and 2 community outreach studies were associated with lower health care costs and better health outcomes
- Authors found 3 studies related to interventions with major educational components that were associated with improved health outcomes, especially among children
- Findings from this work, the majority of which was conducted with low-income populations, suggest that keeping a population healthy may require medical providers to link with unconventional partners such as housing authorities, food banks, and schools. The inclusion of researchers in cross-sector partnerships to document impact with empirically sound methods may further sustain and ultimately help to scale interventions targeted at the social determinants of health.
- While case managers and care coordinators have become a ubiquitous feature of many healthcare systems, the literature provides an impetus for potentially expanding the scope of services that case managers and care coordinators manage. Careful consideration of these issues may be particularly prudent among health systems that have transitioned to value-based financing or accountable care models, where health outcomes have been explicitly prioritized in performance metrics
- Overall, this study found substantial evidence of improved health outcomes and/or reduced healthcare spending related to interventions that addressed housing, nutrition, income support, and care coordination and community outreach needs. At the same time, this literature can be improved in scope and rigor
- Moving forward, further research, particularly examining a broader set of interventions with methods to determine causal effects on both health outcomes and healthcare spending, is needed to produce a comprehensive understanding of the degree to which interventions to address the social determinants of healthcare improve health and reduce healthcare costs