The Growing Importance of Social Determinants of Health

The objectives outlined by Healthy People 2030 aim to “help measure our nation’s progress in critical areas of public health — and serve as a reliable data source to support organizations and individuals working to improve health and well-being for all.”¹ Failing to achieve these objectives will have staggering societal and economic repercussions, hindering our nation’s overall prosperity.

Recent research, funded by the National Institute on Minority Health and Health Disparities (NIMHD) examined inequities among five historically underrepresented groups — American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander.²

The analysis found that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, marking a significant 41% increase from the previous estimate of $320 billion in 2014. These costs include excess expenditures on medical care, lost productivity in the labor market, and the economic impact of excess premature deaths (younger than 78 years). For racial and ethnic minorities, premature deaths accounted for approximately two-thirds of the total economic burden, while excess medical care costs and lost productivity in the labor market represented 18% and 14%, respectively.²

What we at the Make Well Known Foundation (MWKF) recognize is that addressing the economic challenges stemming from a lack of health equity will grow increasingly complex in the coming years. As we approach the 2040s and 2050s, the United States will undergo a significant blurring of racial and ethnic backgrounds, resulting in “the rising importance of the in-between population of the offspring of contemporary mixed unions”.³ In fact, a recent Census Bureau publication forecasts that by 2044, more than half of the U.S. population will identify as part of a minority group.⁴ This demographic evolution has garnered considerable media attention, heralding our march towards a majority-minority nation. ⁵⁶

Importantly, the increasing number of Americans with mixed racial and ethnic backgrounds implies that the underserved groups of the future will not fit neatly into the categories presently used; they will be more internally heterogeneous and overlapping.⁷⁸ This ongoing shift will likely limit the effectiveness of specific race- and ethnicity-based targeted interventions and require more macro approaches to improving health equity.

An example of this evolving approach is illustrated by the introduction of the new cardiovascular disease risk calculator in late 2023. The American Heart Association PREVENT^TM (Predicting Risk of cardiovascular disease EVENTs) calculator estimates the risk of heart attack, stroke and heart failure. It is novel in that it helps incorporate cardiovascular-kidney-metabolic (CKM) syndrome into cardiovascular disease (CVD) prevention efforts. CKM syndrome, first defined in an October 2023 presidential advisory and scientific statement, refers to the interconnectedness of cardiovascular disease, kidney disease, and metabolic disorders such as Type 2 diabetes and obesity.⁹

PREVENT takes into account traditional factors such as biological sex to acknowledge women’s unique differences in CVD presentation and risk factors relative to men. However, it also leverages the CDC’s social vulnerability index calculator. This includes racial and ethnic minority status but does so in conjunction with socioeconomic status, household characteristics, housing type, and transportation access. Knowing that 80% of a person’s health outcomes are driven by social determinants¹⁰ relying on any one social factor (including race or ethnicity) is not telling the whole story. There is an obvious need to incorporate a more comprehensive view of these factors into clinical care considerations.

MWKF does just that. We focus on historically underrepresented and underserved populations, particularly in the areas of cardiovascular disease, oncology, and diabetes, where these groups are clearly disadvantaged in the healthcare they receive. Presently, our key priorities include enhancing access and awareness of subgroup data, promoting diversity in clinical trials, and improving access to care and guideline-directed treatment.

From our multi-city Community Health Builders Program to our engagement in the White House Challenge to End Hunger and Build Healthy Communities, all our work considers these priorities through three lenses: genetics, culture, and the social determinants of health. By examining, from a macro perspective, how all of these influence each other—especially as demographic boundaries become less distinct—we aim to improve health outcomes for all.

MWKF aligns with the Healthy People 2030 vision of realizing “full potential for health and well-being across the lifespan”¹¹ but acknowledges that addressing the social determinants of health is crucial to achieving this goal, as the traditional focus solely on racial and ethnic minority issues will soon be found inadequate.