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How the Social Determinants of Health Impact Population Wellness

A Moody’s Analytics report used the BCBS Health Index to find that social determinants of health can predict the impact of certain diseases on communities.

Social determinants impact population wellness

Source: Thinkstock

By Jessica Kent

- The social determinants of health, including economic status and demographic factors, significantly drive the impact of chronic diseases and other clinical conditions, according to a Moody’s Analytics report prepared for the Blue Cross Blue Shield Association (BCBSA).

However, the report also found that social determinants are less strongly correlated with the impact of mental health disorders, and they only modestly drive the impact of unique conditions like cancer or substance abuse disorders.

Moody’s Analytics used data from the Blue Cross Blue Shield (BCBS) Health Index, a resource that leverages data from over 40 million BCBS members and calculates how various diseases affect longevity and quality of life.  

The report looked at ten major conditions that affect the overall health of BCBS members, and how socioeconomic, demographic, behavioral, and health system factors drive their impact in different counties across the nation.

“This analysis demonstrates the value of the BCBS Health Index for developing a deeper understanding of how and why community health varies across the country,” Mark Zandi, chief economist of Moody’s Analytics, said in a statement.

READ MORE: What Are the Social Determinants of Population Health?

“The results make clear that to understand how demographic, behavioral and structural factors impact health requires the kind of detailed look at individual conditions that the BCBS Health Index makes possible,” he continued.

Industry stakeholders are already well aware that the social determinants of health are highly predictive of a population’s overall wellbeing. In fact, healthcare professionals often say that 80 percent of patient health is determined by social factors.

But why do certain health conditions seem to affect some communities more than others, and what does this reveal about the health disparities that exist in different parts of the country?

The role of demographics and socioeconomics in health conditions

The five physical conditions examined in the study were high cholesterol, coronary artery disease, hypertension, COPD, and diabetes. Socioeconomic and demographic factors could account for more than half of the variations among counties for all physical conditions.

As the report notes, better health is consistently associated with a strong economy, higher pay, and less densely populated areas. Poorer counties mean poorer health, which often means that individuals experience higher burdens from their health conditions.  

READ MORE: CMS Urges Providers to Tackle Minority Health Disparities

Although the report found worse health outcomes in densely populated urban areas, these places also report lower levels of depression and substance abuse disorders.

This doesn’t necessarily mean that there are fewer cases in these areas. Rather, these findings suggest that individuals in these counties are less likely to be diagnosed and receive treatment for mental illness than they are for physical illness, or that the population health reporting infrastructure in urban areas is not adequately capturing the full impact of mental health and substance abuse disorders.

This is a persistent issue in healthcare. A 2016 study found that although a significant portion of minority populations suffer from a mental health condition, whites were far more likely to be prescribed psychotropic medication than minority groups.

The Moody’s report points out that because mental illness is not always as obvious as physical illness, it might be harder to diagnose and treat. However, mental conditions are often just as harmful to overall health as physical conditions, even if they aren’t always visible.

The relationship of physical and mental conditions to overall health

The BCBS measures the overall healthiness of a population using demographic factors like age and the minority percentage in each area. It also considers the number of people living with obesity, those who smoke, and the level of physical activity in each county.

READ MORE: Humana Pins Social Determinants of Health to Better Quality of Life

The BCBS Health Index groups clinical and mental health conditions into three categories: strongly correlated to overall health, modestly correlated, and uncorrelated.

The report found that all physical conditions examined had strong correlations to the overall BCBS Health Index, meaning that the prevalence of these conditions is strongly tied to the underlying health of a population.

High cholesterol had the strongest correlation to overall health (-0.78), while coronary artery disease, hypertension, COPD and diabetes closely followed.

Depression and hyperactivity were the two mental health conditions examined in the report. In contrast to physical conditions, both had the lowest correlation to overall health, with depression at -0.04 and hyperactivity at 0.04.

These findings suggest that the impact of mental health conditions is driven by factors other than socioeconomic status and demographics.

Instead, the prevalence of these conditions depends on providers diagnosing and treating them, which happens less frequently in areas with lower socioeconomic status.

Unique conditions like lung and breast cancer were moderately correlated to overall health, meaning that they are modestly related to socioeconomic and demographic factors, but also to genetics.

The BCBS Health Index not only includes a total overall BCBS Health Index, but also calculates the conditions that drive that score. These condition scores measure how many quality life years have been lost due to that condition, and show how individual condition scores vary in certain places.

It is worth noting that depression and hyperactivity were found to have the highest county average. Across all counties examined, BCBS members lose an average of 0.61 percent of their quality life years to these conditions.

Other noteworthy findings from the report include:

  • Hypertension had the second-highest impact on overall health (0.51 percent of quality years lost) and diabetes had the third (0.45 percent years lost)
  • Behavior was the second-most important factor in explaining variation. Behavior alone could explain nearly half the variation in COPD and hypertension, and one-third of the variation in coronary artery disease and diabetes
  • Health system factors were the least important in explaining variation, but still caused a significant amount of variation among counties
  • The report found education to have a mixed effect, with a college degree improving the diabetes impact score by 0.23 standard deviations, but worsening the hyperactivity score by 0.25 standard deviations
  • The effects of aging were also inconsistent, with the 65 and older population having a worse effect on seven out of ten conditions and overall health, but having an improved effect on hyperactivity, depression, and substance abuse disorder

The report states that this information is critical to understanding population health at the local level.

“Blue Cross and Blue Shield companies are dedicated to addressing social determinants of health at the local level by identifying geographic areas of opportunity and targeting services to improve health in communities,” said Maureen Sullivan, chief strategy and innovation officer for BCBSA.

BCBSA hopes that these findings will reinforce the need to improve the circumstances that affect population health, both physical and mental.

“This analysis also shows the need for continued improvements in the economic opportunities and social influences that drive healthy behaviors within a community,” Sullivan added.


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