Published on December 23, 2019
By Amogh Rajan, Product Manager
Let’s go beyond the buzz: social determinants of health (SDoH) is a phrase that’s been repackaged by healthcare, for healthcare. The concept itself, however, is more than half a century old and was first introduced in the 1943 paper, “A Theory of Human Motivation,” by American psychologist Abraham Maslow.
The World Health Organization (WHO) Europe defined the Social Determinants of Health in 2003, and that version that has been greatly iterated on today. In the U.S., SDoH assessments did not begin to appear within healthcare workflows until 10 years after that in 2013. Highly generic but non-billable Z-Codes did appear around 1999 as a part of the transition from ICD-9 to ICD-10, but healthcare organizations are still trying to wrap their heads around what these really are and how addressing them improves health outcomes and reduces costs.
One thing must be clarified right off the bat: SDoH is not clinical; it’s social. It impacts clinical outcomes, but to approach it as another clinical protocol is a major blunder.
Broadly, SDoH is defined by WHO as “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities – the unfair and avoidable differences in health status seen within and between countries.”Though this statement might seem obvious, its understanding is incomplete without a review of Maslow’s Hierarchy of Needs.
In his 1943 paper, Maslow introduced the concept of “The Hierarchy of Needs,” a theory he expressed in the form of a five-tiered pyramid. The five tiers represent hierarchical human needs. Human needs lower down in the hierarchy need to be satisfied for us, as humans, to even care about needs higher up in the hierarchy. The five tiers within this pyramid are:
- biological and physiological needs,
- safety needs,
- the need to feel loved,
- the need for self-esteem, and
- self actualization.
Applied to healthcare, this hierarchy translates into what’s described by the medical industry as SDoH.
SDoH is not the “thing” but the thing that gets you to the thing. Here’s what we mean:
Notice how the “Carrot Health SDoH Hierarchy” pyramid describes the highest level as the “desire” to live a healthy life. Satisfaction of needs lower down in the hierarchy does not guarantee a healthy life but instead motivates the patient/member to utilize healthcare appropriately, to care for themselves, to take their medications on time and to live a long fulfilling life. Health plans and providers need to understand this and strive to address human needs lower in the hierarchy by getting more involved with their communities. By doing so, they uplift their community’s desire to improve their health and thus health outcomes. In this light, addressing SDoH is not the thing (improved health outcomes) but what facilitates the thing (desire to live a better life) that then leads to the thing (improved health outcomes).
By looking at these needs as basic human needs, health organizations will avoid the mistake of medicalizing SDoH. It will empower health organizations to go beyond the buzz and clinical protocols as embodied by a set of highly general ICD-10 Z-Codes and SDoH assessments.
P.S. At Carrot Health we help healthcare organizations get to improved health outcomes (“the thing”) by leveraging consumer data (in combination with clinical data) and encouraging health organizations to address the appropriate needs all along in the hierarchy. Our models have been validated in the market and are proven in Growth (identifying consumer needs), Health (improving metrics like ED over-use, admissions and readmissions, cost of care, and mortality), and Quality (closing gaps in care and improving customer satisfaction). Identify the bottleneck that your members face, and remove it!