Money and love are the primary social determinants of health, according to our newly published research. Although not the focus of our healthcare system, they may play an important role in our health.
Social determinants of health are non-medical factors that affect health outcomes, such as income, education, employment, and social context. In fact, clinical care affects only 10% of mortality, and half of the county-level variation in health outcomes is attributable to social determinants of health.
Many metrics and indices have been developed to assess social determinants of health. Among them, the International Classification of Diseases established a set of standardized diagnosis codes in 2015 to capture patient information about social determinants of health. Healthcare providers can use these codes to record such information during clinical encounters, presenting a research opportunity to understand the prevalence of various social determinants of health.
After analyzing 2.5 billion medical claims from 2020 to 2021, we found that low income is the most frequently recorded social determinant of health for Medicaid patients, while for commercially insured patients, the primary determinant is the relationship with a spouse or partner. The lack of money and love are the most prevalent social determinants of health for Medicaid patients and commercially insured patients, respectively.
The results do not provide evidence that these social determinants of health directly impacted patients’ health status. Unobservable factors may contribute to low income or partner conflict while simultaneously influencing health. Additionally, it is plausible that being unhealthy might lead to low income and partner conflict.
However, it is reasonable to conclude that, among all standardized diagnosis codes for social determinants of health, the lack of money is most closely associated with our health. In a better financial situation, the absence of love becomes the main factor.
Physicians understand the importance of social determinants of health. In fact, the Merriam-Webster Dictionary defines medicine as “the science and art of dealing with the maintenance of health and the prevention, alleviation, or cure of disease.” As reported by the Washington Post, a pulmonologist gave a “perfect” prescription to his patient who was feeling sad and depressed after the loss of her cat: get a cat.
Poor primary social determinants of health—the lack of money or love—can be diagnosed, and correct prescriptions can be written, but they cannot be resolved by the healthcare system, because ultimately, we as individuals hold the key to improving our own primary social determinants of health.
As I wrote in an earlier article, active income (money) is earned through efforts to serve customers and clients. Similarly, healthy relationships are payoffs from good decision-making plus investment of time and effort. We have the best knowledge of our circumstances, and it is our own actions and efforts that earn money and love, potentially contributing to better health.
Delegating to others the responsibility to improve one’s own primary social determinants of health risks suboptimal health outcomes and fiscal unaccountability. This approach disallows diversified preferences, faces substantial measurement challenges and subdues individual effort. For example, government subsidies to organizations claiming to improve social determinants of health on behalf of low-income patients invite self-dealing and corruption, rather than promoting better patient health.
Instead, why not direct subsidies to the pockets of low-income patients, allowing them to address their primary social determinants of health—the lack of money? Meanwhile, why not create incentives to encourage individual efforts in accumulating wealth and fostering positive relationships?
Make money, find love and stay healthy! Merry Christmas!
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