Healthcare has reached a critical tipping point – society is aging rapidly, people are living longer and cases of chronic illness are increasing drastically. All these factors are putting enormous pressure on systems of care around the world. And, the cost of healthcare is becoming unsustainable. It is estimated that 20 percent of the population generates 80 percent of healthcare costs . Therefore the most logical way forward is to start addressing the social determinants of health.
Education, housing, family conditions, community, employment and social protection all have a direct impact on health: For example:
- Social and environmental factors may contribute as much as 40 percent of the variance in health .
- More than 75 percent of direct healthcare costs are due to chronic conditions which are preventable .
- Providing permanent supportive housing to the homeless community reduces healthcare costs by 59 percent .
- In Europe, overall, death rates among men increased by 44 percent during the first four years following job loss compared with a control group .
These examples make clear the importance of factoring the social determinants of health into planning and implementation with the end goal of sustainable health outcomes. To do this, horizontal policy-making and implementation is necessary – the Smarter Care approach.
Through the IBM Cúram Research Institute, we have identified five activities that are fundamental to Smarter Care: identify, assess, respond, manage and measure. Implemented across the systems of care, they enable the delivery of better outcomes for individuals and society, and ultimately to lower costs.
Incorporating social determinants into care can lead to lower recidivism rates and commensurately lower primary program costs. A multidimensional, holistic approach to healthcare can also improve services, reduce costs and create better outcomes for individuals and society. Although innovation and change will not be easy, making the decision to innovate and change is.
 U.S. Department of Health and Human Services. The High Concentration of U.S. Health Care Expenditures, 2012. Available at: http://www.ahrq.gov/research/ria19/expriach1.htm (Accessed 9 February 2013)
 Institute for Alternative Futures (2012) Community Health Centers Leveraging the Social Determinants of Health. Available at: http://www.altfutures.org/leveragingSDH (Accessed 9 February 2013)
 Centres for Disease Control and Prevention (2009) Chronic Diseases. Available at: http://www.cdc.gov/chronicdisease/resources/publications/aag/chronic.htm (Accessed 2 April 2013)
 Greendoors (2009) The Cost of Homelessness Facts. Available at: http://www.greendoors.org/facts/cost.php (Accessed 2 April 2013)
 The European Foundation for the Improvement of Living and Working Conditions. (2011). ‘Work and health: A difficult relationship?’, Foundation Focus [Internet], (9). Available from: http://www.eurofound.europa.eu/pubdocs/2011/17/en/1/EF1117EN.pdf
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