A look at the history of SDOH and how information technology is heeding the call for data access needed to achieve health equity

Thanks to a new collaboration with LexisNexis Risk Solutions, Health Gorilla will for the first time be incorporating social determinants of health (SDOH) data into our Health Interoperability Platform. Read on to learn about the definition and history of SDOH, how the COVID-19 pandemic has accelerated demand for SDOH data, and the role of healthcare technology.

What are SDOH?

Social determinants of health are defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” They are non-medical factors that shape health in positive and negative ways and include such variables as a person’s socioeconomic status, their education, the neighborhood and physical environment in which they live, employment, and social support networks. Healthy People, an initiative from the U.S. Department of Health and Human Services (HHS), has established 355 science-based core objectives that are measurable and revised every 10 years. 

The HHS and the Centers for Disease Control and Prevention (CDC) have identified five key areas of SDOH:

• Healthcare Access and Quality
• Education Access and Quality
• Social and Community Context
• Economic Stability
• Neighborhood and Built Environment
  

Efforts to improve population health have traditionally been focused on the delivery of care as a primary driver. But it’s become increasingly clear that a broader approach, one that addresses social, economic, and environmental factors, is needed. When talking about modifiable contributors to health, medical care accounts for approximately 10-20 percent while the other 80 to 90 percent are attributable to SDOH.

A Call for Health Equity

The term SDOH has been around since at least 1999, when Michael Marmot and Richard Wilkinson published a book entitled “Social Determinants of Health.” The volume’s main points, all supported by scientific evidence, held that “differences in health between population groups are due to characteristics in society, not differences in healthcare.” Marmot went on to lead the the World Health Organization (WHO) global Commission on SDOH in 2005, and in 2010, WHO provided a “Conceptual Framework for Action on the Social Determinants of Health.” 

The quest for health equity can be traced further back, to 1967 and the UK Whitehall Studies, which predicted the prevalence of cardiovascular disease and mortality based on social status by examining 17,500 male British civil servants for a period of 10 years. From 1985-88, a second cohort of more than 10,000 male and female civil servants 35-55 was studied. The results were conclusive: The lower the social status, the higher the mortality rate. Messengers and doorkeepers were three times more likely to die of cardiovascular disease than administrators. This was dubbed “status syndrome.”

In the U.S., Margaret Heckler, then-Secretary of the HHS, convened a Task Force on Black and Minority Health in 1985 and submitted the first-ever consolidated American report on minority health. However, despite this call to action, a 2019 analysis of 25 years of CDC and Behavioral Risk Factor Surveillance System data from 1993 to 2017 noted “a clear lack of progress on health equity during the past 25 years in the United States.” 

“To achieve widely-shared goals of improving health equity requires greater effort from public health policy makers,” the authors concluded, “along with their partners in medicine and the sectors that contribute to the social determinants of health.”

A Pandemic and a Tipping Point

Because the pandemic shined a spotlight on these kinds of inequities, there has been a renewed demand for health information technology that supports the collection, storage, and sharing of SDOH data.

An abstract published January 5, 2021, in the Journal of Racial and Ethnic Health Disparities found that social determinants of health contribute to COVID-19 mortality. Counties with higher death rates had a higher proportion of Black residents and greater levels of adverse social determinants of health, highlighting the need for public health policies that address racial disparities in health outcomes.

This is just one example of many disparate health outcomes rooted in social and economic disadvantages that show us why social determinants of health matter.  

“We are at a tipping point for bringing a population health perspective in health improvement journeys, and I believe that continuing a focus on SDOH is imperative to long-term success,” Sindhu Kutty, partner and co-founder at Kuroshio Consulting, wrote recently in Forbes. 

As an advisor on leveraging and incorporating digital technology and tools, Kutty said she expects the ramping up of innovative, sustainable and increasingly digital ways to improve population health outcomes to continue. 

Karen DeSalvo, MD, then-President of the Society of General Internal Medicine, wrote that with accelerating healthcare sector adoption of SDOH technology tools and platforms, it’s important not to replicate our mistakes. The electronic health records (EHR) systems borne of 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act were “built to enable compliance and billing, not to support clinical care and decision making,” she says.

“Thus far, the tools being developed are more interoperable, better at respecting privacy and at sharing information with the consumer and are more affordable than the EHRs we implemented,” Salvo said. “This gives me hope that we will have a national social care information technology platform that is useful for many important purposes beyond clinical care.”

Health Gorilla and LexisNexis Risk Solutions

Through the new collaboration with LexisNexis Risk Solutions, Health Gorilla will integrate four clinically-validated SDOH scores into its national Health Interoperability Platform, which supports a diverse set of use cases and enables the entire healthcare ecosystem to securely share actionable health data. The scores include medication adherence, motivation, total cost risk, and 30-day readmission probability and give care coordinators and healthcare professionals critical insights into the well-being of individuals they treat.

"We're confident that pairing SDOH with our clinical data will enhance the way healthcare organizations identify care gaps, reduce treatment costs, and increase their ability to provide personalized and coordinated prevention plans," said Avery Haller, Director of Business Development at Health Gorilla.

Access to this new data will also expand Health Gorilla's ability to support healthcare and community organizations by reducing data collection burdens. Teams that choose to leverage Health Gorilla's clinical and SDOH data simultaneously will be able to create predictive models to measure the risk of a specific population, accurately evaluate the effectiveness of social services, and elevate how they monitor population health interventions. 

"Our team understands that there are a variety of contributing factors that can impact an individual's or a community's health and well-being," said Steve Yaskin, CEO and Co-founder of Health Gorilla. "It's been a goal of ours for some time to integrate SDOH data into our platform, and we're thrilled to partner with LexisNexis on this initiative. They're proven leaders in the space, and I'm confident that together, we can enhance how community health initiatives are developed and improve their outcomes.”

Read the press release to learn more about this new partnership.

About Health Gorilla

Founded in 2014, Health Gorilla is a National Health Information Network with a cutting-edge Health Interoperability Platform that enables the entire health care ecosystem – patients, payers, providers, digital health solutions, and labs – to seamlessly share health data and aggregate each patient's entire clinical history in one place. With enterprise-grade clinical data APIs and an unparalleled Master Patient Index (eMPI), the Health Gorilla network makes it easy for providers to pull their patient's information from any clinical records system. For more information, visit healthgorilla.com or follow us on Twitter @HealthGorilla.

About LexisNexis Risk Solutions

LexisNexis Risk Solutions harnesses the power of data and advanced analytics to provide insights that help businesses and governmental entities reduce risk and improve decisions to benefit people around the globe. We provide data and technology solutions for a wide range of industries including insurance, financial services, healthcare and government. Headquartered in metro Atlanta, Georgia, we have offices throughout the world and are part of RELX (LSE: REL/NYSE: RELX), a global provider of information and analytics for professional and business customers. For more information, please visit www.risk.lexisnexis.com and www.relx.com.