Leveraging Social Determinants of Health and Cultural Competence

Social determinants of health, as conceptualized by the World Health Organization (WHO21), are non-medical factors that influence health outcomes such as “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” These structural factors include socioeconomic and political contexts and mechanisms (such as policies and proxy indicators of income, education, occupation, race and ethnicity, gender, and social class) which influence intermediary determinants (such as housing and neighborhood quality, work environments, behavioral and biological factors, psychosocial factors, and health systems). Relatedly, the Centers for Disease Control and Prevention (CDC) defines SDoH as non-medical/non-clinical factors, including structural conditions and social conditions, that influence healthcare outcomes.

Even though it is increasingly accepted that an individual’s health is determined primarily by factors outside of the healthcare system SDoH and actionable interventions are currently infrequently documented in patient medical records. Nevertheless, the impact of SDoH can be assessed and utilized (at the population and community level, as well as individual and clinical levels) to improve research (clinical, behavioral and social science), population health outcomes, and policy development using tools of data analytics and AI. SDoH and health equity are two of the three priority areas listed by the US government in the Healthy People 2030 initiative, along with health literacy . Healthy People 2030 categorizes SDoH into economic stability, education access and quality, neighborhood and built environment, and the two additional categories below:

1. Healthcare access and quality: e.g., goals to increase patients with online access to their medical records and information they need; to reduce the proportion of individuals who cannot access healthcare or prescription medicines when needed.
2. Social and community context: e.g., goal to increase social and community support through increased use of information technologies to track personal healthcare data and communicate with healthcare providers.

Specifically, we aim to study SDoH factors including the Social Vulnerability Index (SVI), and other measures such as the childhood opportunity index, zip codes/locations, financial struggles, and domestic violence, and then identify which SDoH elements are the most important. These are potentially important factors that hospitals/healthcare systems do not budget for, and which would require creative and synergetic solutions related to, for example, food deserts, housing or transportation. Research is needed on how SDoH contribute to health inequities. To accomplish this aim, we will leverage Patient Advisory Boards and External Advisory Boards, along with the institute research expertise. The resulting tools (thrust 3) will then be deployed through clinical decision support to engage the healthcare providers at the point of care. The algorithms could also be deployed through dashboards and report generation to enable healthcare systems to enhance the patient population health management tools for optimized healthcare decision making and clinical patient care.

This value-added healthcare can also foster optimized patient outcomes via appropriate referral to social services and collaborative team outreach with community partners, further leveraging the other thrusts. We further note that transportation issues are related to multiple SDoH elements. Unavailable, inadequate, and unreliable transportation affects patient access and optimal utilization of healthcare services, especially for individuals who are economically disadvantaged and people with functional limitations. The institute will forge equity-focused links to other UIC urban, community, and transportation initiatives.

At the same time, we aim to study cultural competence, which denotes the interaction data collected from patients and providers. In particular, we aim to study patient education interactions through the SDoH lens, i.e., how to operationalize effective practices using SDoH; e.g. not suggesting to patients who live in high-risk neighborhoods to “take walks in the neighborhood”. In our study of cultural competence, we will leverage UIC’s Hispanic speaking provider expertise, human factors in design expertise, and Natural Language Processing expertise.