According to the National Institutes of Health (NIH), 84% of health outcomes are attributable to a combination of factors that fall under the umbrella that is social determinants of health.
Social determinants are environmental and social factors that impact residents’ health, including housing, food access, transportation, employment, education, violence, incarceration, pollution and more.
The impact that these factors have on one’s health cannot be overstated.
“One of the most powerful factors on social determinants of health in the US is our income,” Dr. Adeola Sonaike, Ph.D., MPH, CHES, chief operating officer of Baker Street Behavioral Health tells New Jersey Business Magazine.
She points to the New Jersey County Health Rankings on CountyHealthRankings.org, which ranks counties based on health outcomes and health factors each year.
“Interestingly enough, the top five and bottom five counties always tend to be the same,” Sonaike says. “The counties at the top [of the rankings] have the highest property taxes, best schools, best parks, etc., compared to the bottom counties that have the highest levels of crime, highest school dropout rates, and highest Medicaid populations, among other factors.”
Cathy Bennett, president and CEO of the New Jersey Hospital Association (NJHA), says that during her time as state health commissioner, and now leading NJHA, the issues of social determinants have been a major focus.
“The issues go back centuries, but modern focus on these issues traces back to the mid-1900s as it became clear that sanitation and environmental factors impact health, particularly cancer diagnoses,” Bennett explains. “Widespread acceptance that socioeconomic status and poverty affect health has grown steadily for 30 years. New Jersey hospitals and health systems have invested heavily in these issues. They perform a Community Health Needs Assessment every three years to identify their community’s most pressing needs and focus efforts and resources on programs to address them.”
Bennett adds that every community is different, so drilling down into the unique challenges in each is essential.
“One of the new initiatives I spearheaded at NJHA was the creation of a Vulnerable Communities Database (www.njha.com/Vulnerable-communities) that provides data for every zip code in New Jersey, analyzing health indicators like low birthweight babies and premature deaths, as well as social issues such as high school graduation rates and employment status,” she says.
“There’s a famous line that your zip code is more influential to your healthcare than your genetic code,” says Carol Ann Campbell, public relations advisor for the New Jersey Health Care Quality Institute (NJHCQI). “You can have all the talent and the best hospitals in the world, but if the people don’t have the ability to have good food or a safe place to live, then it doesn’t matter.”
She adds that change begins by looking beyond the walls of the hospital.
Since 2006, NJHCQI, in partnership with the New Jersey State League of Municipalities, has run the Mayors Wellness Campaign (MWC) – a statewide community health initiative that provides evidence-based tools and strategies to mayors to address the social determinants of health within their communities.
“Through the MWC, we ask mayors to take an annual pledge to improve the health and wellness of their community,” says Julie DeSimone, program officer for the Mayors Wellness Campaign. “We then provide them and their wellness committees with tools, resources and technical support to identify their community needs and take action. We perform this work with the support of health systems and providers in New Jersey, foundation funding, community partners including mental health providers, yoga or fitness instructors, teachers and school nurses, and many volunteers.”
One specific example of work done via the MWC was throughout the pandemic, where NJHCQI asked mayors and their local MWC leads to identify their highest priority needs, which included increasing social isolation and mental health concerns.
DeSimone says that in response, NJHCQI created tools, including: a Social Isolation Toolkit, which offers a step-by-step guide to identifying and matching volunteers with older adults in the community to reduce social isolation: and a Mental Health Toolkit, which includes an overview of mental health and common mental health problems, strategies and program ideas that communities can implement to address mental health, and resources to share with residents who need mental health services and support.
MWC also recently released two additional Social Determinants of Health Tools, including one that shares focuses on food security and how mayors can support their residents’ access to nutritious foods, and a second that provides an overview of land use planning and community health, resources for incorporating health considerations into land use planning, and evidence-based land use strategies.
While finding a single solution to solve all the issues posed by social determinants of health is likely a fruitless effort, one thing that the industry agrees on is the value of partnerships.
“There is not an individual-level solution to this problem, which is why it’s important for policymakers and decisionmakers to come to the table,” says DeSimone, adding that she feels there is a lot of work to be done. “From a MWC standpoint, the thing that is really exciting is that mayors and community leaders are getting on board and are understanding the need for collaboration and more education.”
When asked what are the best weapons to combat the social determinants of health, Bennett responds: “Data to drive smart policy, funding to invest in these social factors that influence health, and a commitment to equity across our communities. While individuals can engage in behaviors that improve their own health, social determinants are issues that require the collective efforts of government, policymakers, the education system, social services, community groups, healthcare and more.”
“We recognize the importance of collaboration and partnership between the community-based nonprofit sector and the private sector,” Sonaike adds. “Taking those who know the communities and have been working with them for decades and partnering them with the system administrators and the people in charge of building the infrastructure – where the funding and the dollars really are – is vital.”
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