Jim Wooten, MBA, MPH
Geomark Consulting, LLC
Importance of Location-Based Social Determinants of Health
One of the important outcomes of the COVID-19 pandemic was the renewed focus on the social determinants of health (SDoH), particularly as they disproportionately impact vulnerable communities. The World Health Organization (WHO) defines the SDoH as “…the 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.”1 Among a list of determinants2, several are location-based:
• Safe and healthy housing
• Reliable transportation
• Neighborhood security
• Access to healthy foods
• Access to social services
• Access to parks and open spaces
• Access to hospitals, ambulatory service centers, and urgent care clinics
In 2020, the National Committee on Quality Assurance (NCQA) created a Social Determinants of Health Resource Guide to help health plans and clinically integrated networks with their SDoH efforts. From among the SDoH identified, three variables were determined to be effective: food security, housing security and transportation3.
According to a 2017 American Hospital Association guide, “3.6 million people in the United States do not obtain medical care due to transportation issues.” As it is a covered benefit under Medicaid plans, healthcare organizations have relied on non-emergency medical transportation (NEMT) to provide transportation for some populations. Increasingly, however, more hospitals and other healthcare organizations are using rideshare companies (Uber, Lyft) to provide these services but it is not widespread.
Many healthcare organizations are also recognizing the impact of safe and stable housing. Some are attempting to fill the gap by investing in building affordable and safe housing. Others are partnering with social services organizations that can provide the housing or direct the patient to providers of housing in the communities where the patient resides.4
To address food security, some healthcare organizations assist patients by establishing partnerships with food pantries and other healthy food providers. In New Jersey, several healthcare providers are partnering with farmers’ markets as a source of healthy food.5
What is the importance of more precisely identifying the location of SDoH? As with any not-for-profit organization such as health systems and government payers, limited resources bring greater importance to allocation decisions through strategic planning. There may be no greater priority than optimizing constrained resources as healthcare organizations move to value-based care. Identifying the most important determinants impacting the health of the people who live in the communities served by each provider is essential. This is where the use of geographic information systems (GIS) tools and technology can be a critically useful tool.
GIS allows healthcare strategists to visualize and assess the SDoH that have the most impact on the health of the community in which they operate. It allows providers and payers to understand the infrastructure that is already in place (or is lacking) to provide the most efficient interventions with the best potential return on investment. It allows the isolation of a variable of interest (i.e. current housing) in spatial relationship to the location of a healthcare organization’s facilities. The image below highlights several such SDoH variables. These layers can be “shuffled” to visualize the spatial relationships among the most important determinants as identified by the provider as likely to have the most significant clinical result in their geographic area.