Understanding Health Equity: The Social Determinants of Health

Research has shown that 80 percent of an individual’s health outcomes is determined by where they live, work and play, which means that zip codes are actually a stronger predictor of your life expectancy than your DNA.  

The places and experiences that people encounter in their lives are often referred to as the social determinants of health (SDOH), a term that specifically refers to the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. According to data from the National Library of Medicine, “medical care accounts for 10 to 20 percent of the modifiable contributors to health outcomes for a population,” while the other 80 to 90 percent is made up of one’s social determinants of health. These can include elements such as socioeconomic status, education, food security, community safety, neighborhood location, and their healthcare system. Now, more than ever, it’s clear that technology and internet access are increasingly important social determinants of health.

The differences in the social determinants of one's health can drastically impact their health trajectories, which leads to health inequity. Health inequities are defined as the “systematic differences in the health status of different population groups.” Simply put, evidence has shown that disadvantaged or underserved populations face increased difficulty accessing healthcare and frequently receive lesser quality care than their more advantaged counterparts.

These structural inequities, which are oftentimes the result of interpersonal, institutional and systemic biases, dictate whether or not one’s social determinants of health have a positive or negative impact on their overall health. For example, a 2008 study found that the life expectancy for adults with fewer than 12 years of education was equivalent to that of adults in the 1950s and 60s. Education is a major social determinant of health that is often affected by institutional biases that discriminate based on gender, race or class. Another study from 2020 found that education levels and race and ethnicity impact infant mortality rates. Study results showed that African American women with a college education faced higher infant mortality rates than white women with a high school degree or less. African American women experienced shorter gestation periods that were attributed to social disparities that made pregnancy more difficult, leading to preterm birth and infant death.

A major aspect of health equity is implicit bias, which is defined as “a form of bias that occurs automatically and unintentionally, but affects judgments, decisions, and behaviors.” Patients can experience interpersonal biases when they interact with medical professionals. Though this implicit bias is unconscious, many studies, including one 2015 review found, “at least moderate implicit bias in most medical professionals.” Whether the bias is focused on race, class, gender, sexuality, religion or otherwise, it can still be pervasive enough to affect the quality of care one receives. 

Health inequity is an issue that needs to be at the forefront of the healthcare industry’s focus. As digital therapeutics increase in necessity and popularity, digital-first solutions may be a solution to health inequities that we face. However, in order to create successful digital-first solutions, they need to be data-driven. At Anthem, Inc., our focus is improving consumers' lives as well as communities. One way we do this is by leveraging the massive amounts of member-specific data available to us around social determinants of health to identify need gaps and connect health plan members to appropriate resources. These data-driven insights across our markets and businesses give us valuable information about how we can build or identify digital-first solutions that will help consumers lead healthier lives. As we move forward, our goal is that these digital-first solutions will be interoperable for easy information transfer between the member, their providers, and us.