Over the last several years, there has been growing awareness of health inequities (Gomez et al, 2021). Healthy People 2030 set the important goal of achieving healthy equity within the next decade. To accomplish this goal, the Social Determinants of Health (SDOH) play a key role. SDOH are described by the CDC as, the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. Gomez et al., (2021) go further to explain the conditions are the environments in which we were born, live, learn, work, play, worship, and age – which all influence health and well-being, quality of life, and most importantly are responsible for health inequities.
According to Gomez et al. (2021), the 5 overarching goals that relate to achieving health equity that are outlined in Healthy People 2030 include:
- Attaining healthy, thriving lives and well-being, free of preventable disease, disability, injury, and premature death.
- Eliminating health disparities, achieving health equity, and attaining health literacy to improve health and well-being of all.
- Creating physical, social, and economic environments that promote attaining full potential for health and well-being for all.
- Promoting health development, healthy behaviors, and well-being across stages of life.
- Engaging the public, key constituents, and leaders across multiple sectors to take action and design policies that improve the health and well-being of all.
In Healthy People 2030, the five key areas of SDOH are: healthcare access and quality, education access and quality, social and community context, economic stability and the neighborhood and built environment. Let’s explore each one a little further.
Healthcare Access and Quality
Within the United, States about 1 in 10 people don’t have health insurance. Peole without insurance are less likely to have a primary care provider and may not be able to afford the health care services they need. Thus, the overarching goal related to key area is to increase access to comprehensive, high-quality health care services. It is critical to increase insurance coverage rates to ensure that all people have access to preventative care and screenings, chronic disease management, and treatment services. There are several evidence-based resources to improve health and prevent disease that are related to health care access and quality. Some include creating patient-centered team-based primary care, high blood pressure screenings, improving patient flow and reducing emergency department crowding, and improving access to oral health services (Office of Disease Prevention and Health Promotion, n.d.).
Education Access and Quality
Education plays another important role in a person’s health within several different ways. For example, children who live in a low-income neighborhood, children with disabilities and children who experience social discrimination (i.e., bullying) are more likely to struggle with math and reading, and are less likely to graduate from high school and go to college. In addition, if a person lives in a stressful environment (which impacts brain development), and/or grows up in a poorly performing school district – each of these factors has an impact on long-term health outcomes. The overarching goal related to this area is to increase educational opportunities and help children and adolescents do well in school. Across the board, people with higher levels of education are more likely to live longer healthier lives (Office of Disease Prevention and Health Promotion, n.d.).
Social and Community Context
Connection with other people (family, friends, co-workers, and community members) have a major impact on health and well-being. Within a person’s environment they may experience unsafe neighborhoods, and discrimination which can have a negative impact on health throughout life. Meaningful and positive relationships can reduce the negative impacts. The overarching goal related to this area is to increase social and community support. Building community and social support is vital to health equity (Office of Disease Prevention and Health Promotion, n.d.).
Within the U.S., 1 in 10 people live in poverty, and many Americans can’t afford healthy food, health care, and housing all of which contribute to a person’s health and well-being. Equitable financial resources are a critical aspect of health equity. The overarching goal related to this area is to help people earn steady incomes that allow them to meet their health needs. Employment programs, career counseling, high-quality childcare can all help people find and keep jobs. Policies that help people get access to healthy food, health care and education can help improve health equity (Office of Disease Prevention and Health Promotion, n.d.).
Neighborhood and Built Environment
Neighborhoods that experience high rates of violence, unsafe living conditions (i.e., lead exposure, water and air pollution), and food desserts all have a negative impact on a person’s health and well-being. Racial/ethnic minorities and people with low incomes are more likely to live in neighborhoods that experience these risks. The overarching goal to this area is to help create neighborhoods and environments that promote health and safety. Improving neighborhoods by adding sidewalks, lighting, quality food options, transportation services, healthcare and social services help to promote safer neighborhoods (Office of Disease Prevention and Health Promotion, n.d.).
On January 10, 2022, the four Managed Care Organization’s (MCO’s) in Nevada presented to the Washoe County Health Policy Board what they are doing to promote health equity and address the social determinants of health. The four organizations include: Health Plan of Nevada, Silver Summit Health Plan, Anthem, and Molina. Each organization discussed what they are working on specific to behavioral health initiatives to address social determinants of health, and health equity.
Health Plan of Nevada (HPN) representatives say that they are committed to removing barriers and creating access to healthcare and community resources for their members, the community, and those who serve them, to live healthier lives. They are committed to providing the right care, at the right place, at the right time through their 24/7 nursing advice, transportation services, medicine on the move program, virtual visits, and urgent care house calls. They provide free haircuts, enhanced transportation and free bus passes, free mobile phones, test prep classes, and support for obtaining Nevada ID cards and birth certificates. In addition, they offer their members gym memberships, healthy food rewards, boys & girls club membership, enhanced dental services, and memberships to Sam’s Club. They are working to address the local housing need through their survivors of human trafficking program, medical respite, transition housing for youth and adults, along with sober living options. Their behavior health model of care includes several components which include a mobile crisis support team, same day behavioral health services, a behavioral health support center, comprehensive provider network, embedded care coordinators, community care and coordination support, telehealth, and wrap around services that address SDOH (Health Plan of Nevada, 2022).
SilverSummit Health Plan representatives shared that their purpose is to transform the health of the community one individual at a time. They are focused on supporting individuals’ whole health, as well as, being actively involved in the local communities. Through their member focused approach, they support members by providing continuity of care, culturally relevant care, health literacy education, health incentives, outreach and targeted intervention, and benefits education. They work with providers to deliver education (cultural competence training, SDOH integration), ensure continuity of care, provide outreach, training, and tool kits, and provide value-based contracting. They support the community by providing education, community investments to support outreach, and by leverage connections with community-based organizations. They reported investing $940,000 within the state to support a homeless case manager, detention center staff, affordable housing funding, funding for Reno PD tele-health crisis system, housing, food security, COVID vaccinations, and workforce development (SilverSummit Health Plan, 2022).
Anthem representatives stated that as Nevadans, they are committed to improving the health of fellow Nevadans while enhancing equity and resiliency within our communities. Health equity work includes a health equity manager who lead’s a Health Equity Collaborative with other MCO’s to share trends and best practices. In addition, they have launched several studies to examine racial, ethnic and gender disparities in services within their SDOH programs. They stratify members by risk to ensure and coordinate their services and support. They offer a wide range of services which include wellness and prevention (emphasis on staying healthy and promoting healthy behaviors, offering educational resources, sending prevention reminders and notification of care gaps, access to Anthem wellness centers, and offering digital, telephonic concierge team access). To support members who need care coordination, they offer services to help members address any needs they have in order to maintain health and manage chronic conditions. They do this through care coordination, community health workers, and by partnering with community organizations. Members who need case management services receive intensive member-centric outreach, high touch holistic engagement, access to case managers, and face-to-face telehealth. When it comes to supporting behavioral health, they have a care management team which includes licensed behavioral health case managers who are available for field-based face-to-face interventions (in Washoe and Clark County), and licensed case managers who conduct comprehensive health screenings and assessments. Effective 2022, Anthem case managers will provide additional support for members aged 21 and younger who are residing in residential treatment centers to ensure seamless transitions between various levels of care (Anthem, 2022).
Molina Healthcare of Nevada representatives shared they aim to improve the health and lives of their members by delivering high-quality health care. They are committed to building resilient communities by partnering with 300+ community-based organizations to address the increased need for essential food and supplies, rental, and utility assistance, employment, and any other needs. They collaborate across SDOH domains to implement innovative solutions that promote health equity, eliminate social risk factors, and meet individual social needs of Molina members to improve health and wellness. They support individual needs through lead abatement, pest control, access to nutritious food, self-defense classes. Additionally, they offer transportation to providers, health education, health improvement programs, legal assistance, peer support, social/extracurricular programs, access to specialist and learning institutions, books and supplies, language courses, assistance with housing, meaningful employment, and financial assistance. Molina’s Behavioral Health Model is described as a non-delegated model that is managed in-house and focuses on whole person care. Molina supports person-centered, evidence-based, trauma-focused and recovery-oriented model of care (Molina, 2022).
They reported that the Molina Cares Foundation will commit $3 million over the next four years to address critical priorities, such as the need for equity and fairness in healthcare within the state of Nevada. The funding will support, The Molina Cares Health Equity Innovation Fund,
Developing a SUD community of care, Eradicating syphilis in partnership with UNLV, NV Health Centers, Southern Nevada Health District, and Washoe County Health District (Molina, 2022).
Gomez et al. (2021) states, “No single individual, organization, community, or sector has sole ownership, accountability, or capacity to sustain, the health and well-being of an entire population.” It takes every one of us to promote health equity for all.