Comorbidities and Social Determinants of Health

What do comorbidities and social determinants of health have in common? Both can have an outsized impact on a person’s health. Both also tend to occur in groups. For example, just as anxiety and depression are frequent comorbidities for people managing chronic conditions, people struggling with housing are likely to have difficulty with employment, nutrition and healthcare access. For healthcare providers, this presents challenges and opportunities.

Understanding the Challenges

 It’s no secret that comorbidities have a major impact on a person’s health. Not only can comorbidities lead to more emergency medical situations, but also people with comorbidities have poorer functional status, quality of life and health outcomes.

In addition, comorbidities take a toll on the health system. Research shows that people with comorbidities are more likely to have longer hospital stays. And prolonged lengths of stay are associated with increased costs.

Similarly, social determinants of health can negatively affect both the patient and the provider. For example, research shows that people with social disadvantages are at higher risk for hospitalization, especially for chronic conditions.

From a provider’s perspective, because social issues such as housing, hunger, transportation and safety affect a wide range of health risks, they can make it difficult and seemingly impossible to achieve positive health outcomes for patients. For example, a physician may prescribe the right medicines, but if the patient has no transportation to the pharmacy, a positive outcome will elude them. And even with the right medications, a person who is malnourished cannot achieve optimal health.

Embracing the Opportunities

Comorbidities and social determinants of health are both big issues that present daunting health challenges. However, they also represent opportunities for healthcare providers.

First, when healthcare providers understand the prevalence of comorbidities, they can be better prepared to treat patients appropriately. According to the National Institutes of Health, 6 in 10 U.S. adults have a chronic condition, and 4 in 10 have two or more diseases. Chronic conditions are more prevalent among certain groups, including girls and women, individuals older than 65, those living at the poverty level, and members of particular racial and ethnic groups.

When treating a patient with a chronic condition, providers can take the opportunity to consider potential comorbidities that might affect treatment outcomes. Not taking into account comorbidities can lead to worse clinical outcomes, as treating one disease and not another may speed up the debilitating effects of the comorbidity, leading to hospitalization or disability and driving up healthcare costs.

Similarly, providers should take the opportunity to find out about the social issues that may be contributing to a patient’s negative health outcomes. By building connections in their communities with food banks, domestic violence shelters, transportation programs and career services programs, healthcare providers can quickly and easily refer patients to the people and programs that may be able to help meet their needs, translating into better lives and better health outcomes.

For example, the American Medical Association offers Social Determinants of Health: Improve Health Outcomes Beyond the Clinic Walls, a tool kit for medical practices to use in creating a plan for addressing social determinants in providing clinical care. “If we’re really going to get to health improvement broadly in this country, it’s going to be when we marry what we do in the office with work our organizations might be able to do in the communities to improve the conditions under which people live, work and play that actually determine health,” said David Ansell, MD, MPH, senior vice president for community health equity and internal medicine physician at Rush University Medical Center in Chicago, who helped develop the tool kit.

Care Management and Social Determinants of Health

Part of the strategy for better addressing comorbidities and social determinants of health can be making use of a digital care management solution designed for this purpose. Such a solution should:

• Enable access to robust data and digital collaboration tools that keep providers informed of a patient’s full range of challenges, including comorbidities and socioeconomic disadvantages.
• Feature a streamlined closed looped referral module to address and appropriately respond to the patient’s social care needs.

Bring national and community-based organizations together within a healthcare organization’s existing provider network, making it easy to connect patients with extensive resources that can help improve health outcomes.