The topic of health equity has been in the spotlight for years within the public health realm, but only since the COVID-19 pandemic hit the country a year ago has the topic of health equity become so prominent in mainstream news. Something once discussed chiefly among policy experts and health communicators is now splashed across news headlines and debated around the dinner tables of Americans across the nation.
Health inequities are differences in health status or distribution of health services among or between populations that are avoidable and that lead to unfairness and injustice in healthcare. An example of health inequity is that Black mothers are four times more likely to die during pregnancy than those in all other racial or ethnic groups or that non-white populations have a substantially greater COVID-19 infection rate than those in white populations.
In fact, research has shown that when assessing a person’s health, their ZIP code is often more important than their genetic code, with only 10% to 20% of an individual’s overall health stemming from the clinical care they receive. Meanwhile, as much as 40% of a person’s health can be attributed to social and economic factors.
Addressing health equity challenges
There have been tools designed that can help mitigate health inequities. Healthcare technology can help democratize access, enabling underserved populations to reach care on a level that was not previously available. However, there is a human element to technology that cannot be avoided; technology, while a great help, cannot solve these problems alone. Rather, there must be a conscious leadership decision to open technology to those who might not otherwise have access.
By understanding and mitigating social determinants of health (SDOH), healthcare technology providers can help bring about health equity for all patients. But what exactly are we talking about when we talk about health equity? And what are social determinants of health?
Defining health equity and social determinants of health
The Robert Wood Johnson Foundation definition of “health equity” is straightforward: everyone has a fair and just opportunity to be as healthy as possible, regardless of their social position in the community.
Social determinants of health are not the same as health inequities. Rather, SDOH such as socioeconomic status, access to healthcare, education level, exposure to stigma, and experiences with racism are underlying, contributing factors of health inequities.
Examples of SDOH might include:
- Safe housing, transportation, and neighborhoods
- Racism, discrimination, and violence
- Education, job opportunities, and income
- Access to nutritious foods and physical activity opportunities
- Polluted air and water
- Language and literacy skills
By addressing these factors as a regular part of their offerings, healthcare organizations can take a critical first step in ensuring that patients are being treated fairly and more important, equitably, when seeking care.
The term SDOH is often used interchangeably with other terms concerned with equities and disparities. However, they are each distinct terms.
In addition to “health equity,” SDOH are commonly mistaken for:
- Social needs — Social needs are the downstream effects of SDOH and social risk factors on the community. A lack of safe housing or lack of access to nutritious foods are social needs — the patient is hungry today, the patient is homeless, or the patient cannot afford their medication. Social needs compromise patient ability to achieve better health and wellbeing.
- Social risk factors — Social risk factors are specific adverse social (non-medical) conditions that are associated with poor health, like food insecurity, housing instability, or lack of health insurance. A person may have social risk factors but fewer immediate social needs. Social risk factors have important effects on health and on healthcare. Housing instability for an individual is considered a social risk factor for that person.
- Health disparities — Healthy People 2030 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Disparity implies a difference of some kind, whereas inequity implies unfairness and injustice and is avoidable.
By recognizing the distinctions between these varied concepts, it becomes easier to see how many of them ladder up to health inequities, which can then be tackled on a systemic level.
Considerations for technology in healthcare
While providers and staff have a vitally important role to play in addressing health equity concerns, there’s no need to go it alone. Health tech solutions exist that can both personalize and scale the services being offered. As with the introduction of any new tool, however, there are some important things to take into account.
One such consideration: Who can actually access and interpret the tools at hand? One subset of health equity is digital health equity, which HealthcareITNews breaks into five facets:
- Tech access
- Tech literacy
- Standard of care
For example, to have access to resources like tools that enable registration for the COVID-19 vaccine, people must first have digital access. If this need is not addressed, entire swaths of the population will get lost in the shuffle.
Another concern is a fundamental lack of diversity and understanding on the side of technology providers, healthcare staff, and others who may come into contact with patients or design tools for their use.
A recent HealthcareITNews article explored this issue, quoting a source who noted that “biased people create biased technology.” The healthcare industry itself is recognizing that shortcomings on the technology front impact patient care, pushing technology providers to address SDOH and health equities in their own organizations before their solutions ever make it to the healthcare setting.
Technology is neither inherently good nor bad — when artificial intelligence is used, however, biased technology can iterate on itself. By training providers and technology companies to recognize the value and importance of health equity, the end result can be beneficial to all patients.
The future of health equity and how technology plays a role
Technology can help intervene by tracking and understanding the non-clinical side of the patient experience, ensuring that SDOH and other factors are being taken into consideration for care.
Creating access to healthcare resources for vulnerable populations via tools that use familiar devices, familiar faces, and plain language and meet people where they are helps connect patients with much needed resources. Such personalized and scaled offerings effectively address the needs of vulnerable populations and ensure health equity for all patients.
The bottom line
Technology is an important tool in the healthcare toolkit. In terms of addressing health equity challenges, understanding the importance of social determinants of health, social needs, social risk factors, and healthcare disparities is a good first step. Ensuring the technology that’s deployed can account for these factors is even more crucial.
By using tools that take the humanity of patients and the systemic challenges they face into account, healthcare will be one step closer to leveling the playing field — for all.