The current health care ecosystem incentivizes provider organizations to perform services that treat illness instead of those that keep people healthy. Many people think of health in terms of medical care and physical health, or simply, the absence of sickness, but that isn’t a complete perspective.
The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition, plus the recognition that drivers of health (DOH) account for 80-90% of health outcomes, exhibits the interdependent nature of health. DOH are defined as “all the circumstances in a person’s life that affect their health and quality of life status. These include access to quality health care, plus predominantly non-medical factors, such as education access and quality, access to and affordability of healthy foods, social connections and support, stable employment and housing, safe neighborhoods, clean air and water, and more.” Yes, we need to treat illness, but we also need to prevent it if we seek to improve health. Addressing DOH is a way to do that.
As defined above, social connections or social health are a driver of health. Social health expert Kasley Killam defines social health as “the dimension of an individual’s overall health and well-being that stems from quality human connections.” Social health is essential to our overall health, but the health care system doesn’t operate in a way that prioritizes it, treats it, or prevents the results of poor social health like loneliness and social isolation. This needs to change, and it is starting to change. But for real impact, we need both providers and insurers to wrap their hands around the problem, which I discuss more below.
Status of social health
A 2023 Gallup survey found that nearly one in four people in the world feel fairly or very lonely. In 2022, the American Medical Association declared loneliness a public health concern. And just last year, the US Surgeon General, Dr. Vivek Murthy, published an advisory on loneliness and social isolation, declaring it an epidemic. His advisory reports that not only do approximately half of American adults feel lonely, but also that the number of close friendships people have and time spent with others has declined (See Figure 1).
Figure 1: National Trends for Social Connection
Source: Office of the U.S. Surgeon General.
Further, a 2023 Pew Research Center survey found only 46% of Americans feel a connection to people in their local community, and 64% of Americans don’t feel a sense of belonging at their place of employment, according to 2021 data from the American Immigration Council and Over Zero. Since social health or social connection impacts our health, this information is troubling. Poor social connection is associated with increased heart disease, stroke, anxiety, depression, and respiratory illnesses. Also, loneliness and social isolation increase the risk of premature death by more than 25%.
Modularity and social health
Modularity Theory (also known as the Theory of Interdependence and Modularity) states that when performance isn’t good enough and a system’s components are unpredictably interdependent—that is, the way one part is designed and functions depends on the way another part is designed and functions and vice versa—then the only way forward is for an organization to wrap its hands around the entire problem. One entity must address every critical component in the system so that it will function adequately. Then, once performance is good enough, the process can become standardized. This standardization creates a state where modularity can thrive, enabling many entities to compete to deliver one or more parts of a service more cheaply and quickly.
Social connection and social health is a fairly new area that many people are exploring and researching. There is likely much that we don’t know about it, but based on what we do know, we need to take an interdependent approach. That’s because health is interdependent. So, we need an entity (in this case, two entities) to wrap their arms around the entire problem. We need providers and insurers to wrap their hands around the issue of how social health is both addressed in clinical care and reimbursed. Only in that case can the health care industry improve social health, and in turn, overall health. The reason we need both entities to wrap their arms around the issue is because they are the two key players in health care that enable the delivery and payment of health care, and they have wholly different roles and responsibilities. Due to their interdependence with one another in our health care ecosystem, one can’t effectively change the status quo without the other.
There have been pockets of innovation where entities are succeeding at alleviating loneliness. These include providers engaging in social prescribing. Providers can improve people’s social health by educating them on the importance of social connection to their health, how to create and maintain quality relationships, and suggesting events where people have the opportunity to interact with others.
Insurers role in prioritizing social health
However, we also need insurers to take a leading role by incentivizing social health through their reimbursement models. When I interviewed leaders from community-based organizations for my report, From child welfare to well-being, one of the leaders at a leading CBO said, “No money, no mission,” when I asked him what impedes the organization from doing its work. That stuck with me. A person, an organization, or a group, can have the best intentions and want to do great work, but if they don’t have a way to fund it, it’s not going to happen.
In order to prioritize and improve social health, we need insurers—the ones reimbursing providers for health care services—to support and provide adequate reimbursement for issues concerning social health. This will incentivize and help providers to provide these services. Without both insurers and providers wrapping their arms around the problem of social health, the health care system is unlikely to make meaningful improvement in social health factors, which impact overall health.
