Covid-19 Exacerbates SDoH Challenges

June 10, 2020

If ever social services providers needed to adopt a social determinant of health (SDoH) strategy-driven by data, COVID-19 is the king of all reminders. Early on, the pandemic has demonstrated its proclivity for infecting at-risk populations impacted by SDoH, the nonmedical life factors that affect health. In managing SDoH influencers, social service providers are also asserting their response to COVID-19.

“This is not just about COVID. COVID is a funhouse mirror that is amplifying issues that have existed forever,” said Shreya Kangovi, MD, MSHP, Associate Professor Medicine, Perelman School of Medicine at the University of Pennsylvania. She noted the reality is that as people lose their livelihoods and income to the pandemic, they defer preventative care and healthy behaviors.[i]

“People are not dying of COVID. They are dying…of economic inequality and it is not going to stop with COVID,” she explained. “The positive feedback loops between poverty and pandemics is very well established.”

SDoH Defined

According to a well-known 2018 published study by the Kaiser Family Foundation (KFF)[ii], six SDoH factors account for between 80-90 percent of health outcomes.[iii] KFF SDoH factors include:

1: Economic stability – Employment, income, debt, and medical bills

2: Neighborhood & Physical Environment – Housing, transportation, and Zip Code safety

3: Education – Literacy, language, early childhood education, and vocational training

4: Food – Hunger and access to healthy options

5: Health Care – Access to providers, quality of care, linguistics & culture

6: Community/Social Context – Social integration, community engagement, and Discrimination/stress

SDoH in the Time of Pandemic

The current COVID-19 pandemic needs for social services is great. Increased SDoH stress is driven by such COVID-19 pandemic factors as:

1: 30 million citizens from all demographics have lost their jobs in the past two months and have filed for unemployment. African-Americans have been especially hard hit in the current pandemic.[iv]

2: Consequently, free and charity clinics are overburdened.

3: Food insecurity is on the rise, with some rural states (Alabama, Arkansas, Tennessee, and Kentucky) identifying up to half their population at risk for food insecurity.

4: Domestic and other interpersonal violence rise as much as 40% in some areas.[v]

Recent survey (April 2020) findings reported by HIT Consultant, which specializes in healthcare technology, provides evidence that a robust data platform to identify client SDoH risk factors during the COVID-19 pandemic is a viable tool for social services providers.[vi] The survey found that:

1: At-risk consumers underestimate the non-clinical drivers that impact their wellbeing. People overestimate the degree to which clinical care and genetics influence their health. Consequently, at-risk populations are less likely to appreciate the impact personal choices have on their overall wellbeing.

2: Increased SDoH risk is evolving rapidly with unprecedented job loss in the past two months. The survey also found that the surveyed at-risk population has not been keeping their clinical providers up to date on their changing SDoH risk factors.

3: Consumers don’t understand what SDoH risk factors they should be sharing with their providers. With the availability of new Z Codes to document SDoH risk factors for reimbursements, proactively identifying SDoH risks is critical in funding care.

Data Platforms are a Key SolutioN

State health departments and academics are using SDoH data to predict COVID-19 risk and needed services. A robust data platform to link providers and resources in a management strategy is a proven action solution. Such an integrated approach removes silos that can improve medical outcomes and cost efficiencies, according to a 2019 Institute for Medicaid Innovation paper.[vii] In other words, – if social service providers effectively manage SDoH risk factors, they are, in turn, likely adopting a more effective response to the COVID-19 threat.

One such public social services effort, All In, is an emerging data-sharing network for “sharing or for scaling up an existing collaboration to mount an effective response to COVID-19…that help communities build capacity to address (SDoH)…”[viii] The initiative has launched with social services provider participation from Los Angeles, Chicago, and Cleveland. For example, Loa Angeles County has been working for years to break down data silos between various departments that provide services to at-risk populations. It has adopted a duo strategy, developing two data information hubs. The first hub is to enable service coordination, while the second informs decision making to improve service delivery.

Such data-driven SDoH platforms are essential in this time of pandemic. Amy Andrade, former Assistant Vice President of Research, Meharry Medical College, said that providers must have a data strategy to manage SDoH and COVID-19 threats to their clients.

“Our health isn’t taking place in the doctor’s office – it’s where we live, where we work, and where we play,” said Andrade. “You have to step back and look at those influences. If providers and health systems don’t have access to this information, then they’re not seeing the true picture of what’s influencing health. You can’t just look at it in a siloed fashion.”