How PCPs can use social drivers of health 'to affect positive change' in their communities

Key takeaways:

• Recent data offer a thorough picture of the social determinants of health affecting patients across the U.S.
• Experts discussed how PCPs can use this information to make a difference in their communities.

The 2024 ranking of the healthiest communities in the United States can shed light on the social determinants of health that primary care providers should be aware of, according to experts.

U.S. News & World Report recently released this year’s Healthiest Communities rankings, which are broadly built around the social determinants of health and include 92 metrics that inform the analysis, Julia Haines, data editor for U.S. News, told Healio.

“Each metric can help to capture what communities are good at and their areas for improvement, both of which are useful for primary care providers,” she said. “Our Healthiest Communities rankings project provides a unique opportunity to access widespread, reliable data at the county level.”

Daron W. Gersch, MD, FAAFP, vice speaker of the American Academy of Family Physicians, said that the social determinants of health can be described as the “conditions under which people are born, grow, live, work and age.”

“The factors that strongly influence health outcomes include a person's access to nutritious food, education, shelter, transportation, employment and include other factors such as exposure to violence and discrimination,” he said. “There has been research that shows that only approximately 20% of health is determined by health care, leaving the other 80% of health up to the environment in which a person lives.”

Therefore, the new data can also offer clues to the factors that may contribute to a patient or community’s poor health, Haines said.

“That in mind, PCPs specifically may find many aspects of these rankings useful,” Haines said.

Getting to know your community

For example, Haines said that Sioux County, Iowa, was ranked fourth overall, but a PCP might note that 38% of that county has obesity.

“While recommendations for patients may default to suggest a better diet and exercise, additional metrics in our analysis can paint a more thorough picture,” she said. “The data show that more than one in five adults in the county do not report spending leisure time on physical activity, and while about 28% of the county’s population lives within 0.5 miles of a park, property crime and violent crime rates, as well as reduced walkability and the number of extreme heat days per year, may hinder the reality of actually using those parks for physical activity.”

Similarly, Sioux County is ranked highly for access to grocery stores, but sugared or sweetened beverages account for much of the food expenditures. Additionally, the local restaurants “may not have the healthiest options,” she said. A PCP might want to consider these factors and tailor their recommendations accordingly.

“We hope that PCPs see the value in this analysis and turn to it as a resource to better understand their community,” Haines said. “If nothing else, providers can use our rankings as a data-driven resource, helping to put their patients’ challenges into perspective and highlight not only where their community has room for improvement, but also where their community can celebrate relative success.”

For PCPs, getting to know the community and considering the social determinants of health that affect its health can also promote health equity, Gersch said.

“Primary care can mitigate health disparities that improve the patient's access to care and utilization of low-cost but high-value care that ultimately results in better patient outcomes and population health,” he said.

Equity

Inequities are vital to the picture of a community’s overall health, which is why the Healthiest Communities report considers 11 different metrics in four key areas of equity: educational, health, income and social.

“The highest scoring communities in the equity category perform well because they are able to demonstrate sustained stability across groups, meaning the lived experience of those in the community is less driven by an individual’s gender, race, ethnicity or disability status,” Haines said. “For example, poverty rates for Black or Hispanic populations should not be notably different from poverty rates for white or Asian populations in the same community.”

For many communities across the U.S., “equity is not the reality,” she added.

“For counties that see large disparities and therefore rank poorly in the equity category, the first step could be to look into why those disparities exist, and have leaders and policymakers take action to better promote equity in their communities,” Haines said. “Additionally, our rankings are relative, meaning even the top-scoring county in the equity category may not have perfect outcomes, and in many cases, our metrics alone cannot capture the true reality of inequity.”

Gersch said long-standing systemic social and health inequities — insurance, language barriers, transportation, cost of care and health literacy, for example — have put many people from underrepresented populations at a higher risk for poor health outcomes.

“PCPs should realize that they are uniquely connected to their communities and witness firsthand the social and structural inequities that are present in their communities, and that makes us well positioned to intervene and reduce the health disparities,” Gersch said. “Sometimes we get so busy taking care of each problem as it shows up in the clinic that we forget to step back and look at the broader picture and say, ‘why is this happening to everybody in the first place?’”

“I think PCPs and family physicians have that ability to step back and look at the entire community and say, ‘What can we do to improve the social determinants of health for our community, and thus increase the health of our community?’” he added.

Although the rankings “can reveal whether a community struggles with large health disparities, a lack of insurance coverage or access to PCPs in the first place, the data alone cannot always capture the ‘why’ behind those realities,” Haines noted.

“Our Equity category identifies whether communities struggle with disparities in metrics like income or premature death rates, but local community leaders or a local community of health care providers may have more insight and context about how those disparities could be addressed, and what providers can do to support that effort,” she said.

To gain more insight and potentially help close the gaps in care, Haines encourages PCPs to examine the data of neighboring counties to see how their communities compare.

“This may spark conversations about effective policymaking, creative solutions and shared resources,” she said.

Making a difference

Gersch said that, because PCPs take care of “the whole person, and often the whole family and the whole community,” they are uniquely well positioned to make a difference in their communities.

“PCPs provide comprehensive, patient-centered care, and they should always consider how these external factors are impacting their patient's health and well-being, keeping in mind that, for different patients, different social determinants of health could come into play,” he said.

Gersch noted that PCPs often intervene and connect patients to social services that help address barriers to care, such as food insecurity, transportation and housing.

“Family physicians can also mitigate health inequity by collaborating with governments, businesses and educational systems to affect positive change for their patients,” he added.

In fact, he knows quite well that paying attention to social determinants of health can make a major difference in a community.

Gersch, a family physician in central Minnesota who has worked in primary care for 30 years, said he noticed the many elderly patients in his town of about 2,500 people had a difficult time getting to their appointments. Naturally, this meant they were also struggling to access grocery stores and other necessities.

“We talked with the city so that once a week, a bus would come out to the city and drive people to the places where they needed for their appointments and then back home,” he said. “The city funded part of the expense, and then the rest of the expense was funded by tokens that were used at the day of transport. And what we found is that a lot of the businesses picked up the costs of those tokens.”

The program became so successful they were able to expand to some other smaller towns in the area and get the bus running 2 days each week, and “now we have almost this little regional bus transportation system,” Gersch said.

“That was something that we noticed in our community that was lacking, and so then we kind of moved forward and partnered with a government agency,” he added. “I thought that was one really good example of how, even in a small community, you can find resources and do things that are needed.”