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By Sarah C. Threnhauser, MPA

A couple weeks ago I found myself in a great conversation about the future of value-based payments—a future that my colleagues and I agreed would involve social determinants of health (SDH) in some shape or form (see Paying For Social Services ‘Value’ Requires Measuring Cost Impact). Our main takeaway from that talk was that the key to assigning risk of SDH and measurable value to social support services to address them is standardized models and methods—but that presupposes that everyone is on the same page about what constitutes a SDH.

Generally, when health care executives discuss SDH, the conversation is focused on the widely-recognized categories of employment and economic stability, housing, nutrition, and neighborhood context (see Tending To The Social Determinants Of Health – Or Not). And, watching the effect these determinants have on cost has become a big part of executive strategic planning (see Social Risk & The ‘Value’ Of Health Care). But there is another category that is starting to gain more attention—socialization and loneliness.

Earlier this month, the United Kingdom grabbed a lot of attention when the Prime Minister appointed a “Minister Of Loneliness.” This new position will lead a government coalition to develop new policies designed to combat loneliness in the elderly, caregivers, people who have lost loved ones, and the population in general (U.K. Appoints A Minister Of Loneliness). Why has the U.K. taken such a dramatic step? Loneliness is a growing problem across the developed world – and one that has serious health consequences.

According to an article in Scientific American, people with no one to discuss important matters has tripled, 28% of older adults live alone, and one third over the age of 45 report feeling lonely (see  To Combat Loneliness, Promote Social Health; Social Isolation In America: Changes In Core Discussion Networks Over Two Decades; and The Potential Public Health Relevance Of Social Isolation And Loneliness: Prevalence, Epidemiology, And Risk Factors). While social media has helped to stem the tide of loneliness for some people, particularly younger generations, studies have shown that a high use of social media can actually increase perceived social isolation (see Social Media Use and Perceived Social Isolation Among Young Adults in the U.S.).

Isolated individuals who report frequent feelings of loneliness suffer higher rates of morbidity, mortality, infection, depression, and cognitive decline (see Social Disconnectedness, Perceived Isolation, And Health Among Older Adults and Social Relationships and Mortality Risk: A Meta-analytic Review). A survey done by AARP found that 55% of respondents who were in poor health reported being lonely, compared to 24% of respondents who were in good health and 25% of respondents who were in excellent health  (see Loneliness Among Older Adults: A National Survey Of Adults 45+). As former Surgeon General Vice Admiral Vivek H. Murthy noted in a recent article “Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day and even greater than that associated with obesity” (see Work and the Loneliness Epidemic).

And the costs for this isolation are just beginning to be recognized—Medicare spends an additional $1,608 a year for each older person who has limited social connections for an estimated $6.7 billion in added spending (see The High Price Of Social Isolation).

So, is “loneliness” the next big SDH? Considering that research is beginning to reveal that social connections can have larger effects on health than many existing SDH (see Advancing Social Connection As A Public Health Priority in the United States), I think it’s only a matter of time before “social health”—focused on “social activities, social well-being, social network quality, interpersonal communication, social support, and social role participation and satisfaction” —becomes a big part of this conversation (see Evaluating a Measure of Social Health Derived from Two Mental Health Recovery Measures: The California Quality of Life and Mental Health Statistics Improvement Program Consumer Survey).

For more on developing the innovative service lines that will be needed in the future, as the field further embraces the need for SDH-focused solutions, join OPEN MINDS Senior Associate Annie Medina on August 14 for her session at the Executive Summit for The 2018 OPEN MINDS Management Best Practices Institute, Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit & Showcase.

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