When we first launched Socially Determined in 2017, we set out on a journey of discovery to find out what the American healthcare industry and the rest of the world thought Social Determinants of Health meant. That was an eye-opening experience. There was great thinking by organizations like the Centers for Disease Control and Prevention and the World Health Organization. But there were no agreed upon definitions, much less a taxonomy.
Understanding that we need to take a systematic, measurement-based approach, our team at Socially Determined created our own taxonomy and definitions to better focus our research, science, and algorithms. Because we are building a scientific method, we considered the following factors:
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We needed the factors to align with areas of existing research. “Standing on the shoulders of giants” is a good thing. There is an incredible amount of academic and applied research, along with real-world programs that align to topics like poverty, food, and housing. Why not build on the work that is well established or already underway?
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We wanted a manageable set of factors that we thought were the biggest contributors to health behaviors and outcomes. We didn’t have any preconceived ideas about a set number, but in the business of analytics, one cannot have a category called “other” or “miscellaneous.”
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The factors needed to be relatively discrete. We knew we could use machine learning techniques to combine factors, so it is best practice to not incorporate complex interdependency into a single factor.
Our Significant Seven
Our research and modeling has given us confidence that the following seven factors are the right areas to focus on:
Economic Wellbeing
Economics lies at the heart of many problems. We look at how factors like monthly income, employment, cost of living, access to benefits and financial security affect health and wellbeing.
Food Insecurity
Many people live in “food deserts.” For many Americans, the availability of unhealthy food far outweighs healthy food options. We look at how being without reliable access to a sufficient quantity of affordable, nutritious food affects health and wellbeing.
Housing
We have seen direct causal links between housing conditions and certain disease progressions. We look at how crowding and quality of dwellings within an area affect the health and wellbeing of people living there. In addition, we look at how instability in one’s housing affects health outcomes.
Transportation
This is a hot topic today in healthcare with ride-share companies like Lyft and Uber providing billions of dollars of non-emergency transport. We look at transportation grids, general availability and accessibility, and safety of transportation in neighborhoods in relation to health and wellbeing.
Crime & Violence
A wealth of research shows that exposure to violence and crime is detrimental to one’s health. We look at how the prevalence of violent and property crime in a neighborhood affects health and wellbeing.
Health Literacy
We are looking at how the ability to obtain, read, understand, and use healthcare information to make decisions and comply with treatment affects health and wellbeing.
Social Support
This is one of the most important, complex and nuanced social determinant factor. We look at how the availability of assistance from other people and the feeling that one is part of a supportive social network affect health and wellbeing. We also examine triggers that can often occur in a person’s life that takes them from low to high risk in an instant.
We routinely are exploring dozens of additional factors in our analytics. But through our discovery, research, and client work, having these seven simple and intuitive conventions allows us to help our clients easily interpret results in a specified framework.
