Why coalitions are vital to tackle social determinants of health

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Crystal Yednak Senior Manager, Health Research Institute, PwC US March 10, 2020

One player alone cannot address the root causes of disease. But many players do not seem to be trying at all. More than one-third of respondents surveyed in PwC’s 2019 HRI global consumer survey indicated they had not engaged in conversation with any stakeholders about the social, economic, behavioral and environmental factors affecting their health.

Forty-three percent of consumers surveyed mentioned they had discussed those factors with physicians, but pharmacists, therapists, nurses and other health specialists are broaching the topic at a much lower level. This disparity highlights the huge opportunity to engage other health system workers in promoting conversation about social determinants of health. 

It will take a coalition of partners who may need to stretch their roles, but leaders must find ways to show prospective partners how their goals meaningfully align. Constructing the right coalition also will require looking beyond the sector and traditional partners to consider the community groups, government agencies, universities, retailers, technology companies and new entrants that might contribute.

Social determinants of health will require collaboration

Governments can act as conveners by mandating focus, adopting policies that encourage action, providing investment or creating incentives for players to lead

Articulating the overall costs to health systems and society can help motivate players. For example, faced with evidence that the estimated direct cost of medical care attributable to people being overweight and obese increased 61% from 2000 to 2008, Mexico in 2010 launched the National Agreement for Nutrition and Health campaign against obesity. This program gathered five business groups and 15 federal agencies, including the ministries of health and education, to work together with a focus on the school-age population. 

In other cases, companies have stepped up as conveners. In the US, a digital health startup helps healthcare organizations find partners and coordinate to address social determinants of health. It recently announced a collaboration to help connect its complex, chronic patients with medical, behavioral, social and palliative care. Employers are recognizing that a different approach is needed, and some are taking a more activist role.

Building, and funding, the coalition

Though a social determinants of health focus can achieve tremendous savings for the overall system, the payoff may not be seen for years, and may stretch over two or even four election cycles. What can help build support?

  • Public buy-in. It is easy for a culture of defeatism to take over and dampen efforts. Coalitions can develop evidence-based public campaigns to win community buy-in that helps lessen some of the political risk involved in making the up-front investment.
  • Media spotlight. Showing wide disparities in health status of different population segments can increase political pressure to act. 
  • Alternative funding. Coalitions can turn to funding mechanisms, such as social impact bonds, which enable the risk to be shared by government and private stakeholders. 
  • Traditional funding. Aligning public and private budgets from the health and social services sector can maximize every entity’s spending and produce benefits for all. 

Efforts to address social determinants of health often have not scaled beyond the pilot stage because of difficulties in quantifying the immediate and long-term value to risk bearing stakeholders. However, by developing common frameworks and harnessing the power of data analytics, organizations can build the infrastructure that will produce evidence for the business case.

For citations, implications and insights, please read our full report, Social determinants of health: Expanding the health ecosystem to encompass where people live, work and play

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

Erin McCallister

Senior Manager, Health Research Institute, PwC US

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