Why aren’t we healthier? The case for a new social determinants of health approach

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Crystal Yednak Senior Manager, Health Research Institute, PwC US January 22, 2020

The world is growing wealthier. According to the World Bank, about 1.1B fewer people are living in extreme poverty than in 1990. But the greater wealth of nations doesn’t always translate into the greater health of nations. 

Between 1990 and 2010, health spending by OECD countries nearly doubled. And yet people are getting sicker across the world. Rates of chronic diseases such as cancer, diabetes and cardiovascular disease rose consistently from 2000 through 2016. Nowhere is the looming threat to public health clearer than in the rising proportion of people considered overweight or obese. Since 2014, there has been an increase of more than 10 percentage points in the share of the population in OECD countries deemed overweight or obese, from 53.9 percent in 2014 to 65.2 percent in 2017. The epidemic of obesity makes people more prone to a slew of chronic health problems including diabetes, cardiovascular diseases and cancers.

A comparison of outcomes and investments in Japan and the US, two of the world’s most highly developed countries, shows how behaviors and environmental factors may have more of an impact on health than money spent. In 2016, the US spent 17 percent of GDP on healthcare, while Japan spent just under 11 percent for its population, which includes a significantly higher proportion of people age 65 and above than the US. But in the US, 66 percent of residents are overweight, as compared with only a quarter in Japan. And in the US, per capita sugar consumption is almost twice what it is in Japan.

For all the investments already made in healthcare, countries have not been able to bring about the necessary societal shifts to encourage habits that could prevent chronic conditions from developing. Between 1990 and 2010 in the OECD, for example, smoking rates dropped 31 percent. But alcohol use fell only 8 percent, and the rate of daily vegetable consumption increased by just 2 percent. Consumers shoulder some blame, as 43 percent of respondents to PwC’s 2019 HRI global social determinants of health consumer survey said they bore the greatest responsibility for addressing the behavioral, social and economic factors contributing to their health. But that doesn’t mean they are doing anything about it, or that they even know what to do.

In a screen-filled, interconnected world, the state of our brains may be key to unlocking better health. 

Consumers say they are not getting enough sleep, are distracted by smartphones, lack motivation and struggle with mental health issues such as depression and anxiety — none of which sets the right frame of mind for healthy decision making. Thirty-five percent of PwC’s 2019 HRI survey respondents cited a lack of sleep as a top impediment to adopting a healthy lifestyle, and more than a quarter said too much time with technology prevented healthy habits. A host of social factors can feed the lack of sleep — working multiple jobs, caring for family members, lacking proper housing, suffering from stress. 

Twenty-two percent of survey respondents who classified themselves as being in poor or very poor health said mental health concerns such as depression kept them from a healthier lifestyle. Organizations need to determine what programs and campaigns will help consumers in this frenzied mindscape eliminate the obstacles to health and motivate people towards healthier behaviors. 

Social determinants such as employment status, income level, educational attainment, pollution levels and neighborhood crime all affect how people experience the world and the choices they make. In PwC’s 2019 HRI global consumer survey, one in five respondents indicated they could not afford a healthy lifestyle, and a similar share said they did not have the time to focus on healthy behaviors. In fact, clinical care, while vital, is responsible for only 20 percent of a person’s health. The other 80 percent is attributable to health behaviors, the physical environment and socioeconomic conditions.

In a time of robust medical discovery and treatments that seemed impossible a generation ago, the most effective strategy to improving healthcare may lie in a focus on root causes. 

Why do people get sick? Why do they engage in the behaviors that cause their health to suffer? And what environmental and social factors influence those behaviors? To be sure, any institution, or group of institutions, taking on a challenge as intractable as income inequality may seem an insurmountable task. But countries that have more inequality in income levels experience a higher rate of diabetes. Existing business models, incentives and value chains may act as barriers to taking a different approach. Yet our research, work and conversations with industry leaders reveal that the data is available to build a case for urgent action, to identify where and how to conduct interventions and to inform the use of existing technology to amplify such efforts.

For citations, implications and insights, please read our full report, Action required: The urgency of addressing social determinants of health.

For more of HRI’s insights and content, visit our Regulatory Center and report library.

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Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

Crystal Yednak

Senior Manager, Health Research Institute, PwC US

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