We all care about our health, and when things go wrong, we typically blame some combination of bad genetics, risky lifestyle choices, and limited access to medical care or medical resources. Our social environment is a major factor in the relative outcome of our health.
Environmental factors and social factors that influence health outcomes are called the social determinants of health. The link between the state of our social environment and our relative health outcomes is surprisingly robust: just about 40% of health outcomes are attributed to the social determinants of health. Social and environmental factors such as socioeconomic status and access to housing, food, utilities, and safety can drastically alter one’s health trajectory–for better or worse. This reality is exemplified through higher disease rates and measurable health disparities among lower socioeconomic groups compared to higher socioeconomic groups (The National Academies of Sciences, Engineering, Medicine).
Wicked Problems have no clear cause and no clear solution. They are multifaceted, interrelated, and just plain tough to diagnose and solve. In this blog, the NNSI team hopes to (1) illustrate why socially determined health disparities are a wicked problem and (2) outline one approach to addressing such a multifaceted wicked problem.
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Wicked Problem
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1. Why socially determined health disparities are wicked problems
Socially determined health disparities are difficult to define.
- Human health is comprised of compounding factors such as genetic code, access to medical care, lifestyle choices, and social environment
- Bad health could be spurred by one, multiple, or all of these factors
- It is impossible to know to the exact degree and in what exact ways the social determinants play a role in negative health outcomes
Socially determined health disparities are inherently unsolvable
- Even if it were possible to understand the exact impact of social factors on health outcomes, many sub-factors comprise a social environment
- It would be impossible to solve all housing, utility, income, food, and other instabilities across the whole of humanity
- Outside of theoretical utopian society, these disparities are an inherent part of society
Socially determine health disparities pertain to government, social, or policy planning
- Housing, income, food insecurity, and access to utilities are hot topics in government, social, and policy planning
- Divisions such as the U.S. Department of Housing and Urban Development (HUD) and the United States Department of Agriculture (USDA) regularly work to combat these problems. Similar government departments are present in many other countries
2. Addressing the social determinants of health as a wicked problem
The social determinants of health could be considered a wicked problem that cannot be solved once and for all. So, how does one address an unsolvable problem (especially on such a large scale)?
A 2019 study from the National Academies of Sciences, Engineering, and Medicine, “Integrating Social Care in the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health,” offers one possible ongoing solution. The study proposes using five generalized actions to integrate social care into health care slowly. This integration might not wholly solve the issue of socially determined health discrepancies, but it could work to improve health outcomes and minimize such discrepancies. The five generalized actions outlined by this study are awareness, adjustment, assistance, alignment, and advocacy.
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Awareness |
Actions that identify and draw attention to social influences on health and how they impact general groups and specific individuals |
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Adjustment
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Actions that alter the practices of the health care sector to accommodate for social barriers |
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Assistance
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Actions that connect patients in need to social care resources to reduce the impact of social factors on health |
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Alignment
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Actions taken by the health care sector to understand current social care institutions in the community, organize them, invest in them, and deploy them to support positive health outcomes |
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Advocacy
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Activities where health care organizations and social care organizations collaborate to facilitate the creation and redistribution of assets and resources to both health and social needs |
Graphic sourced from the study, “Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health
To reiterate, the ongoing use of these five actions is meant to slowly merge the social care sector with the health care sector and subsequently reduce health inequities caused by the social determinants of health. Such an initiative requires the whole team’s effort, from nurses, physicians, and social workers to personal care aides, family caregivers, lawyers, and more.
Wicked problems cannot be solved, but this study demonstrates that they can be addressed. With a team of determined individuals, the problem of socially initiated health disparities can be combated through awareness, adjustment, assistance, alignment, and advocacy.