5 ways to build healthier societies
Jan. 14, 2020
By 2025, many countries will see rates of obesity exceeding 68%. We should focus on keeping people healthy not just treating the sick. Access to jobs, safe housing, clean water, food, education and transport are key to health.
We have the most advanced medical technologies the world has known, and countries are spending more on healthcare every year — US$8.4 trillion across the globe. Yet after decades of rising life expectancy and improving health outcomes, a modern health crisis is escalating. PwC estimates that by 2025, many countries will see rates of obesity exceeding 68% of the population and other conditions driving chronic health problems.
But why? It’s not that the pace of medical discovery has stalled. Rather, it’s because the social determinants of health (SDOH)—factors such as whether people have access to jobs, safe housing, clean water, food, education and transportation—render even the most innovative medical interventions ineffective when people struggle with basic social and economic factors.
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It’s time for the healthcare sector to take bold action. In a new report from PwC’s Health Research Institute, “Action required: The urgency of addressing social determinants of health,” we outline a critical strategy for collective action.
The case for a new social determinants of health approach
Our global healthcare systems are focused on the wrong interaction point—when people are already sick. And the costs of proceeding in our usual fashion are unsustainable for hospitals, insurers and governments.
In many instances, countries aren’t encouraging habits that could prevent individual from developing chronic conditions. Between 1990 and 2010 in the OECD, for example, smoking rates dropped 31% and the rate of daily vegetable consumption increased by just 2%.
In a screen-filled world, the state of our brains may be key to unlocking better health. 35% of respondents to PwC’s 2019 HRI Global Consumer Survey cited a lack of sleep as a top impediment to adopting a healthy lifestyle, and more than a quarter said too much time with technology prevented healthy habits.
Identifying these root causes is a difficult challenge. But our research, work and conversations with industry leaders reveal that progress can be made if we take the following five steps to build a holistic approach.
Five steps for bold action on social determinants of health
1. Build collective will. One player alone cannot address the root causes of disease, but many players do not seem to be trying. 57% of respondents to PwC’s 2019 HRI global consumer survey indicated they had not engaged in conversation with their doctor about social determinants. It will require a coalition of partners in and out of the healthcare sector, with leaders finding ways to meaningfully align their respective goals.
For instance, Singapore's Health Promotion Board (HPB) set out to lower youth smoking rates by partnering with youth groups to attract participants to weekly meetings. In six months, through programming including a clinic that demonstrated how smoking affected one’s stamina, the board found the rate of smoking in the study cohort fell from 40% to 10%, demonstrating the power of coalitions.
2. Develop a framework to work together. Partners must overcome the challenges of merging disparate workplaces. A guiding framework should establish clear roles, a common vocabulary, goals, definition of value and decision-making protocols. In Wakefield, England, a coalition of partners united in recognition of the impact of housing as a social determinant of health. The coalition agreed on a vision and had their employees spend time in partner organization to increase understanding of their inner workings. The overall effort led to fewer ambulance trips, a reduction in medical crises, and improved mental health treatment—resulting in savings of an estimated £400,000 per year.
3. Generate data insights to inform decision making. In the US, the Visiting Nurse Association of Texas’ Meals on Wheels program used predictive analytics to simulate a virtual population and show how certain interventions impacted their health. The analysis showed that nutritious meal delivery reduced chronic conditions, saving an estimated $10.4 million annually in health costs, and helping its population experience 24 fewer heart attacks, 12 fewer congestive heart failure hospitalizations and 12 fewer strokes. This approach can be employed to simulate a variety of interventions—from installing new walking paths to encourage exercise to offering emotional support to the socially isolated.
4. Engage and reflect the community. SDOH programs must be grounded in how people live and work, and those carrying out the intervention must have the credibility and knowledge to work in the community. In many parts of India, female Accredited Social Health Activists from the community anticipate the barriers to care to solve public health issues and educate people who otherwise distrust unfamiliar health workers. Likewise, in the US, an initiative focused on reducing diabetes in Texas considered how people lived and located screening and prevention programs where residents shopped, enabling them to check their blood glucose and pressure at retailers and assigning community health workers to visit people in their homes. Both resulted in improved health outcomes for the communities.
5.) Measure and redeploy. Successful SDOH interventions are exercises in continuous improvement, in which experience, data and insights are gathered and fed back into the system. In Western Sydney, Australia, a coalition dedicated to diabetes prevention set measurable goals including reducing population weight and HbA1C levels. It then developed a dashboard to measure which interventions worked and track trends in costs. An annual year-end review report and plan for the year ahead inform its strategy and investments.
The time is now
We all have something at stake — governments, hospitals, payers, pharmaceutical companies, community groups, tech companies and new entrants. If we don’t take bold steps, we will be unable to meet the unsustainable costs driven by rising rates of illness. We can identify the conveners who bring groups together while collecting and analysing the data that can spotlight meaningful areas to intervene with supports that can help people make healthier decisions.
It’s time for leaders to step forward by embracing urgently needed social strategies that achieve true health for the world’s populations.
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