Based on your understanding of concepts of health and US values and the history of health care services, why do you think concepts like Social Determinants of Health have not been used as much in the health care industry? In your answer. you can consider the prevailing medical model (p. 53), anthro-cultural beliefs and values (pp. 84-86), and the history of health care services (132-134).
First, the traditional biomedical model that has dominated healthcare views health as an individual biological condition, separate from social and environmental influences (Marmot, 2005). This model promotes focusing on treating illness within a clinical setting rather than addressing underlying social risks. However, we now understand that social and economic factors play a major role in individual and community health (WHO, 2021). Where one lives, learns, works, worships, and plays influences a wide range of health risks and outcomes.
Additionally, the prevailing cultural beliefs in the United States have historically emphasized individualism and personal responsibility over collective action or public policy approaches to health issues (Braveman & Gottlieb, 2014). This perspective makes it harder to gain support for recognizing and addressing social risks that are outside an individual’s control. There is also a lack of awareness among many in the general public about how social conditions directly impact health.
From an economic perspective, focusing on social factors requires a level of cross-sector collaboration and population health approach that the traditionally siloed healthcare system has not been financially or structurally incentivized to undertake (Robert Wood Johnson Foundation, 2014). Within the fee-for-service reimbursement system, providers are rewarded more for clinical services than addressing social needs.
However, as the understanding of social determinants of health has grown (CDC, 2022), so too has the recognition that truly improving population health outcomes requires a multi-pronged approach that includes social and community-based interventions (Braveman et al., 2011). We are now seeing more initiatives emerging that aim to integrate social services with clinical care (Gottlieb et al., 2016). With further shifts towards value-based payment models, there is greater motivation for healthcare stakeholders to work on addressing factors like poverty, education, housing instability that can impact individuals’ health risks and outcomes (Robert Wood Johnson Foundation, 2014).
In summary, while the biomedical model and cultural beliefs have posed barriers, growing evidence and pressures for reform are helping drive more consideration of social determinants of health in the industry. Integrating these concepts into healthcare policy and practice can potentially lead to improved population health and a reduction in health inequities.
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it’s time to consider the causes of the causes. Public health reports (Washington, D.C. : 1974), 129 Suppl 2(Suppl 2), 19–31. https://doi.org/10.1177/00333549141291S206
CDC. (2022, February 24). Social determinants of health: Know what affects health. Centers for Disease Control and Prevention. https://www.cdc.gov/socialdeterminants/index.htm
Gottlieb, L. M., Tobey, R., Cantor, J., Hessler, D., & Adler, N. E. (2016). Integrating Social and Medical Data to Improve Population Health: Opportunities and Barriers. Health Affairs, 35(11), 2116–2123. https://doi.org/10.1377/hlthaff.2016.0723
Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099–1104. https://doi.org/10.1016/S0140-6736(05)71146-6
Robert Wood Johnson Foundation. (2014, October). Time to Act: Investing in the Health of Our Children and Communities. https://www.rwjf.org/en/library/research/2014/01/time-to-act.html
WHO. (2021, August 9). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
