Social determinants of health, variously abbreviated as SDOH or SDH, are described by the World Health Organization as the conditions under which individuals live, work, play and age, and factor into such things as chronic conditions, preventable hospitalizations, morbidity and mortality.
Various studies have concluded, in fact, that SDOH factors into between 60 percent and 80 percent of health outcomes. Tom Lawry, Microsoft’s National Director for Artificial Intelligence, Health and Life Sciences, underscored the point in a June 2022 piece for Forbes, one he began with a quote attributed to futurist William Gibson (though it’s not clear when or if Gibson actually said it): “The future is already here. It’s just not evenly distributed.”
Lawry then went on to cite a MedCity News piece that examined the lives of two 60-year-old women who live near Washington, D.C., a mere 10 miles apart. While they have similar medical histories, one has a life expectancy of 63 years, the other of 95 years, and it’s all because of SDOH – specifically, factors like the women’s respective income and education levels, as well as their access to nutritious foods.
Lawry also quoted a piece from The Conversation that concluded the life expectancy in majority-Black communities tends to be lower than that in other communities – a fact, the piece noted, that is reflective of “the places in which different races live, not the individual characteristics of the people themselves.” That point has been brought home during the pandemic, as Blacks have been twice as likely to die of COVID-19 than those in other demographic groups.
The challenge, then, is for clinicians to be able to root out the necessary SDOH information so they can act proactively on behalf of their patients. That isn’t always easy, as Kim Glenn, senior vice president of government health plans at HHAeXchange, explained in a piece for Managed Healthcare Executive. She pointed out that patients are not always forthright about their habits or background, whether out of embarrassment, concern for their privacy or a variety of other reasons.
Artificial intelligence could make a difference on this front, in Lawry’s estimation, as it could be incorporated into electronic medical records and enable clinicians to act proactively. He pointed to one study, which showed that AI could predict healthcare usage according to certain basic SDOH information, as proof of that.
Clinicians can make a difference by asking the right questions, too. One recent poll showed that eight of every 10 Gen-Z respondents would like to see healthcare professionals delve into SDOH matters, and to that end the Mayo Clinic has incorporated such questions into its check-in procedure.
Admittedly, though, these are unchartered waters for those on both sides of the equation, as the Mayo Clinic’s Dr. Jay-Sheree Allen told Becker’s Hospital Review:
“It’s not intuitive that every patient feels they can talk to their doctor about their housing. You don’t just put ‘doctor’ and ‘housing’ together. You don’t necessarily put ‘I have no food’ and ‘my doctor’ together. It’s important for patients to know that we are a resource for these factors that very clearly impact their health outcomes, even though it’s not the most publicized portion of medicine.”
The bottom line, then, is that clinicians need to ask patients about SDOH-related matters. They need to venture beyond the usual patter about illnesses, potential outcomes, etc. That is just the tip of the iceberg. The factors that determine their health go much deeper and much wider. It’s of vital importance that they too are examined. And technology, including AI, can factor into that.