Transition to whole-person care by addressing SDOH & prevention to improve population health

Over the past 30 years, the US healthcare system has implemented numerous quality initiatives to improve the population’s health. While progress has been made in certain areas, such as reducing smoking and improving screening rates for certain types of cancer, general health outcomes in the US have not significantly improved. In fact, life expectancy at birth in the US has decreased in recent years. Chronic disease prevalence in the United States is higher than in many other developed countries. For example, according to data from the Centers for Disease Control and Prevention (CDC), approximately 6 in 10 adults in the United States have a chronic disease, and 4 in 10 have two or more chronic conditions. As a result, the total national health expenditures over 29 years (1990-2019) have increased by more than five-fold.

Unfortunately, chronic disease prevalence in the United States has been increasing continuously. For example, the prevalence of obesity in the United States has been growing steadily over the past few decades. According to data from the CDC, the prevalence of obesity among adults in the United States was 30.5% in 1999-2000 and had increased to 42.4% by 2017-2018.

The nation’s challenge is the unsustainable HC cost on the national economy and the declining healthy youth for a productive life as the next generation in the labor force. According to a 2018 report from the Council for a Strong America, about 71% of young adults in the United States between the ages of 17 and 24 are ineligible for military service for various reasons, including medical issues such as obesity and other chronic conditions.

The issue of poor population health in the United States is complex and multifaceted. However, here are some of the key drivers that have contributed to the worsening trend:

• The US healthcare system has traditionally placed a greater emphasis on treating illnesses rather than preventing them. This approach is reactive rather than proactive to healthcare, which may not address the underlying causes of chronic diseases. Without a shifting focus on prevention, the overall health of the US will continue to fail to improve. Studies have suggested that up to 80% of heart disease, stroke, and type 2 diabetes cases could be prevented through healthy diet and lifestyle behaviors, such as maintaining a healthy weight, regular physical activity, and avoiding tobacco use.

• Unhealthy food environment: Long-term research has demonstrated that the prevalence of unhealthy processed foods, sugary drinks, and fast-food options has contributed significantly to the increase in chronic diseases, particularly to overweight and obese. The 2018 report found that about 31% of young adults in the United States are considered too overweight to join the military and that this percentage has been increasing over time.

• Lifestyle factors: Unhealthy lifestyle behaviors, such as poor dietary habits, physical inactivity, smoking, excessive alcohol consumption, and overuse or abuse of drugs, have contributed to the increase in chronic diseases, such as obesity, diabetes, heart disease, and premature death.

• Social determinants of health: Social and economic factors, such as poverty, lack of education, limited access to healthcare, and a poor environment (air, water, crime), can also contribute to poor health outcomes. These factors can impact a person’s ability to make healthy choices and access preventive care, resulting in disparities in health outcomes across different populations.

From a population health perspective, one thing is clear: what we have been doing for decades has yet to deal with the root causes. Overall, addressing the issue of poor population health and the increasing prevalence of chronic disease in the United States requires a systematic shift. Shift to a proactive approach to healthcare: Place greater emphasis on preventing chronic conditions before they occur. This can involve investing in preventative care, promoting healthy behaviors, and identifying and addressing social determinants of health.

To address social determinants of health, we must leverage our resources from the government and community to improve access to affordable housing, education, and healthcare. This shift requires transitioning from sick care to well-care, from disease management to whole-person care, by addressing social drivers of health at the community level and delivering social/behavioral care where patients live and work. To address poverty and income inequality at the community level, we must also provide more resources to underserved communities. Some publicly available SDOH data, such as the social vulnerability index (SVI), area deprivation index (ADI), and healthy place index (HPI), can be used to identify these social needs in vulnerable communities.

For healthcare delivery, we must broadly increase access to preventive care and make it more accessible and affordable to all Americans through community centers and CBO partners and leverage technologies such as telehealth, smartphone apps, and mobile clinics. This includes expanding insurance coverage, adding community health workers, increasing funding for preventative care programs, and implementing policies and incentives that support preventive care.

Through member engagement, healthcare must encourage and support healthy eating by improving the food environment. At the national level, this can include implementing policies that limit access to unhealthy foods, adding warnings about sugary drinks and processed food, supporting healthy food options, and improving nutrition education. At the plan level, IEHP is collaborating with community partners to provide resources to address food insecurity, provide healthy diet education, and deliver nutritious meals to support our needy members in recovering their health quickly.

Transitioning from sick care to well care needs broad collaboration beyond the traditional care delivery system. The new frontier would be creating partnerships between the public and private sectors, healthcare payers and providers, and local agencies and community organizations to improve population health where people live and work in the community. California’s Advancing and Innovating Medi-Cal Initiative in 2023 is an excellent example of a framework shift to improve its population health. Preventive care is one of the top strategic initiatives in 2023 at IEHP to address the root causes of many chronic diseases.