The link between social determinants of health and health disparities

Around the U.S., adults and seniors are reporting challenges that influence their health outcomes, from housing instability to lacking enough savings to cover a sudden health emergency, according to recent polling.  

This polling, conducted by Morning Consult on behalf of the PAN Foundation, compared the survey results of a group of adults and a group of seniors on Medicare, summarizing data around financial security, housing, health services, food insecurity, and transportation. 

Many of these results were unsurprising, particularly as we enter the third year of a pandemic amidst a housing crisis. For instance, adults with an income of less than $50,000 expressed the greatest concerns around housing security. People living with a serious illness expressed concerns about food insecurity and transportation availability. 

The data underscores the need to address social determinants of health in a systematic way, an effort which can improve health outcomes and reduce longstanding health disparities. Social determinants of health are the conditions in which people are born, grow, live, and work that shape their health, like housing and socioeconomic status. 

Financial instability 

Across the board, the data showed that many adults and seniors have serious concerns about their ability to afford various everyday needs and bills and could be one health issue away from crisis. About 30 percent of adults said that they could not afford to pay more than $100 for a sudden health emergency, without turning to money they may have in a retirement account. The rate of concern was even higher among adults with an income of less than $50,000 (43 percent), Black adults (41 percent), women (38 percent), and Hispanic adults (33 percent).  

Financial concerns are often tied to health disparities. A poll of PAN patients last year found that 72 percent had trouble paying for their basic needs, including food, housing, and doctor’s visits. 

Housing and utilities 

While a medical emergency presented a big concern to many, adults reported the greatest worries about rent. About 40 percent of adults polled said that it has been difficult to pay their rent in the last 12 months, and nearly 50 percent are concerned about their ability to pay rent over the next 12 months.  

Among adults who reported a concern with affording their bills and necessities over the next year, more than 80 percent said that financial assistance would help to decrease their concerns. Adults who are having trouble affording their rent or other housing expenses often have little left each month to spend on other necessities such as food, clothing, utilities, and healthcare services. People with the lowest incomes may be forced to rent substandard housing that exposes them to health and safety risks or may need to move frequently, which also correlates with lower health outcomes. 

Other health services 

Our polling also showed that significant numbers of adults and seniors were opting out of eye exams and dental checkups because they either lacked insurance or couldn’t afford to go. This wasn’t surprising considering that almost two-thirds of Medicare beneficiaries—37 million people—do not have any dental coverage. Older adults who forgo or delay these services are at greater risk for emergency department visits and hospitalizations, dependence on family caregivers or skilled nursing facilities, and depression and dementia.  

Transportation and food insecurity 

In the past 12 months, about a quarter of adults reported that a lack of reliable transportation has prevented them from getting where they need to go. The rates are even higher among adults with cancer or a rare disease, where about 35 percent said they struggled with reliable transportation.  

Similarly, about a third of adults were concerned in the last 12 months about their ability to feed themselves or their families. Among adults with cancer, the rate jumped to 60 percent.  

PAN continues to expand support for patients beyond their prescription co pays. Dependable transportation can help patients access medical care, which is why we launched a transportation fund in 2020, offering up to $500 in support for qualifying patients for non-emergency medical travel. Thanks to our alliance partnerships with 23 national organizations that provide disease-specific support for patients, we also connect patients with additional resources that can aid in better health outcomes and disease management.  

Policy recommendations 

Addressing social determinants of health is a key policy priority for PAN in 2022. Both policy and public health approaches have the potential to improve patient health outcomes and reduce avoidable healthcare spending, while improving medication adherence and disease outcomes. For example, lack of affordability is one of the primary reasons patients do not adhere to therapeutic recommendations. Public and private partnerships are critical to accomplishing these goals.  

Public and private insurers should adopt policies that mitigate barriers to treatment.

Potential policies could include payment models that incentivize screening patients for social needs—like housing, food insecurity, and transportation—and connecting them with needed services and education. These policies should also factor in the disparities in healthcare and health outcomes that persist in the U.S. as a result of broad structural, socioeconomic, political, and environmental factors that are rooted in years of systemic racism.

Achieving health equity will require coordinated leadership at the national, state, and local governments along with the nonprofit and private sectors to address social determinants of health, increase access and affordability of healthcare services, and collect and analyze data to track progress. It is more important than ever for legislators to improve access and affordability of healthcare for all.