Live from Cannes Lions: The biggest drivers of health outcomes are social determinants. New studies and new ways are creating opportunities to use that understanding to save lives.
Dr. Freddy Abnousi is the Head of Healthcare–Research Partnerships at Facebook and an interventional cardiologist.
At Lions Health, he shared the story of Mr. K, a 49 year old husband and father of three. He came into the hospital with acute, crushing chest pain. Everything went according to plan. He was quickly diagnosed and moved to intervention. His life was saved. It’s the outcome Abnousi says we fight for, but not the one we always get.
When his team wasn’t able to rescue a patient from an acute life-limiting heart attack, he’d spend days asking if they did everything they could. “Could we have done something better, done something different?”
But, he always came back to the same end point: “why did we meet Mr K here, trying to bring him back from the abyss? Why didn’t we meet him earlier?”
Abnousi spends a lot of time thinking about the major drivers of health outcomes, including the top four:
- Exposures (like asbestos)
- Access of quality healthcare
- Social/behavioral factors
We’ve all thought about these for our own health but have you ever weighted them to understand what to prioritize differently?
It turns out the numbers are startling:
- Exposures (like asbestos): 5%
- Access of quality healthcare: 10%
- Genetics: 30%
- Social/behavioral factors 55%
The majority driver of outcomes is social and behavioral factors.
Just as one example, geography can show the radical differences social factors can have on outcomes. Abnousi said, if you’re lucky enough to live in certain counties in California and Colorado, you’re expected to live to 85 years old. If you live in certain counties of Mississippi, you’re likely to die by age 65. That’s a 20 year gap based on where you live.
Traditionally, the levers we’ve had to understand those social and behavior factors beyond geography are limited to :
These are insights based on entire public health datasets that generated observations that are compelling in the macro but generally in-actionable in a 30-minute clinic visit.
It’s the data that’s the problem
Instead of starting with the big census and public health data, Abnousi says we need more granular social and health outcomes data to create more actionable levers of change.
He pointed to two studies as early, interesting examples:
- 76,000 women over a 20 year period
- To understand how social factors – like how embedded a person is with family and community – impact outcomes
- They found: women who were less socially integrated had a significantly higher chance of fatal heart attack, regardless of lifestyle and comorbidity
- Ultimately giving clinicians and advocates a way to score and intervene on a critical social driver of outcomes
- This randomized trial of blood-pressure reduction was run from black barbershops
- To find new ways to address the incredibly high 40% prevalence of the condition in black men
- Two treatment arms were run from 52 shops
- The first focused on lifestyle change with the barber actually acting as coach
- The second added in medication delivered in the barbershop by a local pharmacist
- The first arm earned a 10% drop in blood pressure overall, with 50% of the men considered no longer hypertensive
- The second, a 30% drop overall, with 90% considered no longer hypertensive
To identify social determinants that are even more actionable, there are two remaining challenges:
- Timeline to acquisition of data. The Nurses Study, for example, took 20 years
- Extent of the factors data. The Nurses Study focused on social connectivity, not other factors
To create intervention requires understanding. And Facebook is looking for new partners to help them do it.
This is an existential crisis for people who got into healthcare to provide interventions. We’re invested in the best-in-the-world sick care but barely invested in the # driver of outcomes.
When you see me in Cardiology Clinic, I ask you about your blood pressure, cholesterol, medications, and past medical history. But I, along with every other physician, fail to assess the biggest factor that affects your risk of premature mortality….
The social determinants of health are what really matter. Yet decades of research on the topic have been unable to produce actionable results to curb mortality. Do we dare investigate the source code for nurture?