Addressing health care disparities: Social determinants of health

This article first ran in the March — April issue of Hospital and Physician Update as part of an ongoing series on how we’re addressing health care disparities in Michigan. If you’d like to read additional articles on the topic of health care disparities, subscribe to Hospital and Physician Update, a newsletter published every other month.

According to the National Academy of Medicine,** medical care determines 10% to 20% of a person’s overall health. The other 80% to 90% is determined by circumstances in which people are born, live and age. Called the social determinants of health, these influences have a significant influence on a person’s health. They include:

• Economic stability
• Education
• Food
• Community and social context
• Health care system
• Neighborhood and physical environment

When it comes to where people live, a person’s ZIP code can actually predict their longevity. For example, according to the National Center for Health Statistics,** residents of Grosse Pointe have a life expectancy of 82, while in the Dexter/Linwood area of Detroit, the life expectancy is just 62. The life expectancy in the state averages 78.

These statistics illustrate that health starts long before an illness — or even birth. It starts in our schools, workplaces and communities. Within some communities, access to high-quality health care is limited.

“The research is clear: Social determinants influence health disparities and burden certain population groups with higher rates of illness, injury, disability and mortality,” said Daniel J. Loepp, president and CEO of Blue Cross Blue Shield of Michigan, in a blog on mibluesperspectives.com. “To eliminate these disadvantages, communities must have equal access to the resources that improve quality of life.”

As we wrote in the first article in this series, “Blue Cross launches Office of Health and Health Care Disparities,” one of the challenges to delivering health care in an equitable way is understanding the role that implicit bias plays in health care disparities. That’s why Blue Cross’ implicit bias education for participating health care providers is so important.

Exploring socioeconomic factors 

To help address social needs, Blue Cross is focusing on food insecurity, housing, access to telehealth, health literacy and mental health.

Along the way, we’ll continue to partner with and invest in community organizations across Michigan. 

One such community group is the Baxter Community Center in the Baxter neighborhood of southeast Grand Rapids where 42% of families live on less than $25,000 per year. Executive Director Sonja Forte works closely with residents who access services at Baxter’s health center. 

When residents access services at Baxter’s health center, they fill out a questionnaire that relates to various aspects of the social determinants of health. Forte said it helps guide resources and programming to address barriers such as transportation and child care that make it harder to get to appointments. 

“Missed visits aren’t always because people don’t care or just choose not to go,” Forte said.  

Blue Cross’ social mission

Blue Cross’ longstanding mission is to improve the health of all Michigan residents.

“We’re proud to be the largest private donor to Michigan’s free clinics, providing low‑cost medical, dental and mental health care for safety net programs for the uninsured and underinsured,” said Loepp. “Additionally, our organization has introduced policies that emphasize health equity, cultural competency and the quality of health care delivery. We’re connecting members to physicians, raising awareness of implicit bias through education, supporting organizations to address food insecurity and partnering with foundations to expand access to telehealth services for everyone.” 

If you have a patient who is struggling to afford basic household needs, the United Way’s 2‑1‑1 service can help. This free and confidential service helps people find the local resources they need 24 hours a day, 7 days a week and can be accessed by dialing 2‑1‑1 or visiting 211.org.** 

Previous articles in this series

• Addressing health care disparities: Blue Cross launches Office of Health and Health Care Disparities (January — February 2021 issue of Hospital and Physician Update)

• Addressing implicit bias in health care can improve care delivery (February 2021 issue of The Record)

**Blue Cross Blue Shield of Michigan doesn’t own or control this website.