Can Innovation and/or Technology help with Social Determinants of Health?
-and especially as it relates to older adults?
The term “social determinants of health”, or SDoH for short, seems to be used as “everything that might influence a person’s health other than physical ones”. This includes variables such as a person’s housing situation, proximity to toxins or waste, or the quality of the local air, or even items such as a person’s location, economic status, or level of literacy. This is using the word “social” in its widest possible sense of “relating to society” which can inhibit our opportunity to take an important question (do factors other than physical problems have an impact on health and by how much?) and start to really get a lock on some possible answers. After all, the ultimate goal here is to better understand a whole range of non-physical health influencers and ultimately assess these for their relative impact. If we can do this well, we have a chance to make changes, at a policy level, and give individuals much stronger guidance on what to do as organizations, families and as individuals.
Perhaps a more useful way to think about SDoH is to describe it in 5 levels. These 5 levels of “Determinants of health and happiness” as follows: 1) Environmental determinants, 2) Local Living determinants, 3) Physical determinants, 4) Personal determinants and 5) Social determinants. These are not wholly discreet, as there are clearly some overlaps and many issues within categories can relate in different ways to others. However, each layer does represent a very unique impact or determines health/happiness outcomes in different ways. Given these 5 categories, the pyramid (in graphical form) looks as follows:
In this model, examples of factors are listed under each of the 5 levels of the pyramid, starting with highly tangible external conditions, often beyond an individual’s easy capacity to influence or control (such as air quality or access to public transport). At the next level (and more readily influenced by an individual, at least relatively) are local living conditions (such as whether a home has sufficient heat, or a person is in debt or not). At the next level we move into an individual’s physical determinants of health, some of which are relatively difficult to influence (such as genetics) but including some that could be changed with some effort and focus (such as addictions).
For our purposes here, environmental, local living and physical determinants (the bottom 3 layers) are not “social” ones, as they are likely to prevail and influence people because of factors such as political decisions, economic circumstances and national and local policy choices (which can reflect legal, cultural, technological and other considerations). Truly “social determinants” are the ones at the top two levels. Personal determinants are more self-determined than the bottom three and reflect circumstances that an individual can often change if they are determined (although admittedly often with only considerable effort). This includes factors such as literacy and education levels as well as the type, quality, and stability of work. Finally, at the top of the pyramid are pure “social determinants” or those factors that mainly relate to the quantity, quality, and frequency of relationships with others. This includes not only time spent with friends and family but social pastime participation and even the level of spirituality or altruism felt towards others. Percentages to each of these 5 levels have been assigned to indicate the likely impact of each layer or tier of the pyramid as a whole. This is not only somewhat paradoxical because the lowest levels of the pyramid are incredibly impactful when individual determinants are altogether absent (a homeless person, living in poverty with no work and lonely is likely to quickly experience greater physical and mental health problems, for example, and even fall into cognitive decline or depression) but also almost entirely hypothetical, based only loosely on some limited research done to date. However, these ‘guesses’ serve to provide a starting point for people to perhaps plan to conduct more rigorous studies to come up with more accurate numbers.
Accepting that these are only loose estimates, the impact of the top layer is proposed to have the greatest impact (at a guess of 30%) and personal determinants next at 25%, making over half of the impact on our health and happiness based on social and personal determinants of health. This would clearly suggest that we should focus much more of our time and effort on these two layers and on the individual sub-categories that are under each of them. In practical terms this entails that we are likely to get “more bang for our buck” by focusing much more on items such as building up people’s self-esteem stress-handling capability and confidence, getting them more involved socially (through games and pastimes with others perhaps), developing better approaches to deal with loneliness and social exclusion and even encouraging more civic and social participation. And all of this becomes increasingly important as people age and their personal and social networks change and often deteriorate.
Which startup and early-stage companies are doing this well in the current market?
An article such as this is likely to become outdated very quickly if we produced a list of all the current startup or early-stage organizations that provide solutions to assist older adults in particular and focusing on SDoH specifically. In addition, this may be such companies main endeavor, or part of a wider suite of services provided, of which SDoH is only a part. Nonetheless, in the list below are 5 ‘best-practice’ companies that are providing much of what we have been talking about here as a core part of their service. It is therefore worth looking at each of these web sites to see what they cover in detail and make a judgment call about what how they specifically seek to meet older adult and family needs best and most readily, and also which of these adds the greatest value to the care coordination of individuals and support to the organizations that provide care in a number of different older adult settings.
City Block Health (website: https://www.cityblock.com )
City Block Health’s headquarters is in New York and the CEO is Iyah Romm. The business was founded in 2017. City Block offers individual care (in person and virtually), rooted in a person’s own community, so they can all achieve a healthier life. City Block Health focuses heavily on the community on Medicaid and seeks to understand as much of the SDoH factors that affect each person as possible.
Papa (website: https://www.joinpapa.com/)
Papa’s headquarters are in Miami, Florida and the CEO is Andrew Parker. The business was founded in 2017. Papa pairs older adults and families with Papa Pals (often students and other individuals who can provide service and support) for companionship and assistance with everyday tasks (offering direct transport as needed) taking wider SDoH factors into account as much as possible.
Socially Determined (website: www.sociallydetermined.com)
Socially Determined’s headquarters are in Washington, DC and the CEO is Trenor Williams. The business was founded in 2017. Socially Determined helps organizations to better understand the dynamics of social risk and create actionable programs to improve utilization patterns, reduce costs, and improve health outcomes by incorporating many social SDOH factors into the overall contextual thinking.
Motispark (website: https://www.motispark.com/)
Motispark’s headquarters are in Los Angeles, California and the CEO is Ariel McNichol. The business was founded in 2016. Motispark builds personalized video-based ‘nudges’ mainly for health payers and providers that help individuals to discontinue what might be poor or harmful health behavior and/or adopt better or helpful behaviors or ones that help the person to thrive personally.
Element3 Health (website: https://element3health.com/)
Element3 Health’s headquarters are in Denver, Colorado and the CEO is David Norris. The business was founded in 2015. Element3 Health offers a national network of activity clubs across a broad spectrum of passions to deliver fun, meaningful opportunities for seniors to get active and engaged, physically, socially and mentally. This aims to address physical health and help reduce feelings of social isolation and loneliness.
I realize that these startup companies only a sample of many that are focused heavily on SDoH, and there are many other worthy ones that could have been included. However, these 5 are all engaged in interesting and worthy work in different ways and deserve not only wider attention but much success. Their collective efforts, along with others concentrating on SDoH will make a significant difference in older adult lives and allow people to experience life more positively and have a better chance to thrive.
Jon Warner is CEO of Silver Moonshots-www.SilverMoonshots.org, a research and support organization for enterprises interested in the 50+ older adult markets with its own aging focused virtual accelerator. He is also Chapter Ambassador for Aging 2.0 and on the Board of St Barnabas Senior Services (SBSS), in Los Angeles, California.
