Center for Digital Health

Beyond Biology: Importance of Social Determinants of Health During the COVID-19 Pandemic

Increased utilization of digital health tools during the COVID-19 pandemic has played a large role in health equity by addressing social determinants that impact a patient's overall health.

Photo of a clinician using a mobile tablet with a graphic overlay depicting the world of digital health.

The COVID-19 pandemic has drastically impacted nearly all aspects of our global society. From social distancing to mask mandates to virtual education and Zoom meetings, these unprecedented changes have tested our communities in a number of ways. Over the past year and half, there have been nearly 45 million cases of SARS-CoV-2 infection in the United States, with roughly 724,000 fatalities (1). However, COVID-19 has not impacted all equally. 

The pandemic has exposed both shortcomings in our current healthcare systems and the long history of structural and systematic factors driving health inequalities in our society. Significant disparities have been documented thus far in mortality rates and disease impact across different racial and socioeconomic groups in the US (2). Studies have found that compared to people who are white or living in higher income households, people who are Black, American Indian, or live in low-income households are more likely to have conditions that are associated with higher risk of severe illness from COVID-19, such as cardiovascular disease, obesity, and type 2 diabetes (3)(4). In addition, a large population of minorities and people living in low-income households work in high-social-contact “essential” businesses and often live in more crowded living conditions, thus increasing risk of exposure to COVID-19 and restricting options for quarantining sick family members (3)(5)(6). For these reasons, it is now more critical than ever  for physicians treating patients to understand and keep in mind the “social context” of a patient’s health and well-being.

According to the World Health Organization (WHO), social determinants of health (SDOH) are non-medical factors that impact the health and well-being of patients such as income, education level, employment status and working conditions, food security, housing, access to healthcare, non-discrimination, structural conflict, and more (7). Many even argue that SDOH have a larger impact on overall health and well-being than medical care (7). However, support for SDOH is not traditionally emphasized or  implemented into standard models of care in our healthcare system. It is important to raise awareness of SDOH in the medical community, particularly in the training of rising physicians to ensure the best culturally-competent and comprehensive quality of care for all patients.  

Innovative digital health technologies have great potential to address social determinants of health, to bridge the gap in health inequities faced by minority and under-resourced populations (8). A number of support programs currently exist that aim to target SDOH, however many have faced difficulties and been inactive due to the pandemic. One local, community-based program that successfully adapted to a virtual format to support patients during the COVID-19 pandemic is Connect for Health (formerly known as Health Leads). This program, run by the Lifespan Community Health Institute and student volunteers, works to connect low-income families in the Rhode Island community with basic resource and non-medical needs that can impact a patient’s health such as food/SNAP resources, heating/cooling, housing/rental assistance, transportation support, clothing, education, and more. Connect for Health strives to “integrate basic resources into healthcare delivery” to contribute to the fight for health equity. Prospective patients are often referred to Connect for Health from healthcare providers or are walk-ins at one of four different clinics. The program currently operates at Hasbro Children’s Hospital and Center for Primary Care in Providence. 

In a brief “triage” process, a virtual screening tool is used to document basic demographic and personal information about a patient and identify their specific needs relating to SDOH through questions about assistance for food, clothing, transportation, health insurance, childcare, education, utility bills, housing situation, legal assistance, and more. Information is stored in a secure digital portal, and a profile is created for each patient organizing and outlining their most urgent needs. Patients are then matched to an “advocate” who works one on one with the patient to connect them with specific resources to best fit their needs. This can range from support with filling out food stamp/SNAP applications to helping patients navigate legal support and rental assistance to making appointments for patients at winter clothing donation sites to even helping patients navigate how to vote and more. The digital health portal used by Connect for Health advocates automatically suggests community resources based on patient needs identified during the screening process. In this way, assistance to these families can be streamlined as advocates are immediately informed of beneficial and relevant resources. In response to the COVID-19 pandemic, the program fully converted to virtual operation with advocates directly calling, texting, and emailing the roughly 250 patients in the program ensuring they continue to receive support during these difficult times. In addition, volunteers for Connect for Health speak a wide variety of languages and have access to phone translation services to maintain the accessibility of the program. During remote operation, Connect for Health also worked to connect patients to COVID-testing sites, PPE drop-offs, and vaccination clinics. 

Connect for Health is a model program that has had great success in supporting low-income patients with their basic needs. With the conversion of the program to a virtual format, the highest volume of patients ever were supported over the past year, due to the increased accessibility of the program and ease of use for patients. Particularly during the COVID-19 pandemic, harnessing the power of digital health tools can improve accessibility to care and overall health outcomes for patients. Expansion of programs like this, which address the social determinants of health to supplement medical care from healthcare systems is an instrumental step towards bridging the gaps in health disparities across the US.

 

References

  1. “Coronavirus in the U.S.: Latest Map and Case Count.” The New York Times, The New York Times, 3 Mar. 2020, https://www.nytimes.com/interactive/2021/us/covid-cases.html. 
  2. Paremoer, Lauren et al. “Covid-19 pandemic and the social determinants of health.” BMJ (Clinical research ed.) vol. 372 n129. 28 Jan. 2021, doi:10.1136/bmj.n129
  3. Raifman, Matthew A, and Julia R Raifman. “Disparities in the Population at Risk of Severe Illness From COVID-19 by Race/Ethnicity and Income.” American journal of preventive medicine vol. 59,1 (2020): 137-139. doi:10.1016/j.amepre.2020.04.003
  4. “People with Certain Medical Conditions.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. 
  5. “A Profile of the Working Poor, 2016 : BLS Reports.” U.S. Bureau of Labor Statistics, U.S. Bureau of Labor Statistics, 1 July 2018, https://www.bls.gov/opub/reports/working-poor/2016/home. 
  6. Adamkiewicz, Gary et al. “Moving environmental justice indoors: understanding structural influences on residential exposure patterns in low-income communities.” American journal of public health vol. 101 Suppl 1,Suppl 1 (2011): S238-45. doi:10.2105/AJPH.2011.300119
  7. “Social Determinants of Health: Key Concepts.” World Health Organization, World Health Organization, https://www.who.int/news-room/q-a-detail/social-determinants-of-health-key-concepts. 
  8. Brewer, LaPrincess C et al. “Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health.” JMIR mHealth and uHealth vol. 8,1 e14512. 14 Jan. 2020, doi:10.2196/14512