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Population health

Social Determinants, Finally Out from the Shadows

By Betty Rabinowitz

Blog    Social Determinants, Finally Out from the Shadows

In case you missed it, the American College of Physicians (ACP) recently published a position paper1 calling for the evaluation and implementation of policies and interventions that will reduce the socioeconomic inequalities that negatively impact health. They propose funding for research and medical education as well as across the broad policy steps that will foster a “health in all” approach.

I must admit, the authors highlight some compelling evidence. In 2000, approximately 245,000 deaths were attributable to low education. 176,000 were due to racial segregation, 162,000 deaths were due to low social support, 133,000 were due to individual poverty and 119,000 to income inequality.2 Let’s put things into perspective. The number of patients dying from lung cancer (within the same time period) was similar to the numbers of deaths attributed to low social support.

One of the most compelling facts highlighted in this article is that, in the United States, place of birth is more strongly associated with life expectancy than race or genetics.1

If we know extensive evidence exists to support the pivotal role nonmedical factors play in an individual’s or entire population’s health and life long health outcomes, it is hard to explain how as a nation and health care industry, we have for far too long, ignored the writing on the wall.

ACP specifically recommends "development of best practices for utilizing electronic health record (EHR) systems as a tool to improve individual and population health without adding to the administrative burden on physicians."

I am happy to say that at NextGen we have long recognized the importance of creating EHR care-team centric workflows to support the screening and documentation of social determinants of health, and further in the NextGen Population Health platform (formally known as EagleDream Health) we provide a robust geospatial tool that allows identifying patient cohorts by zip code designation, as well as multiple ways in which to aggregate and analyze social determinants data at the population level. In this regard we are eager and ready to work with our partners to meet the challenges that this new health frontier is presenting.

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1 Daniel H, Bornstein SS, Kane GC, for the Health and Public Policy Committee of the American College of Physicians. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Ann Intern Med. 2018;168:577–578. doi: 10.7326/M17-2441
2 Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. Am J Public Health. 2011;101:1456-65. [PMID: 21680937] doi:10.2105/AJPH .2010.300086


Dr. Betty Rabinowitz MD FACP

Chief Medical Officer

Get in touch with Betty