Connected Health · Public Health
The COVID-19 pandemic has shined a spotlight on many difficult issues facing seniors today, including social isolation, physical estrangement from family, lack of mental stimulation, limited physical activity, and inability to visit healthcare providers except in urgent circumstances. Health care and social welfare thought leaders have increasingly recognized the importance of social determinants of health (SDoH) and their impact on health outcomes and longevity.
Social determinants of health are the conditions of the environments where we are born, grow up, live, work, and age. They include income, marital status, education level, public safety, access to affordable housing, transportation, healthy foods, and social support networks.
The link between social determinants and health outcomes is well documented. One study of 22 European countries found death rates substantially higher in groups of lower socioeconomic status. Another documented the physical and psychological health consequences for women in abusive environments. Research consistently shows that medical care only accounts for 10–20% of all determinants of health — the remaining 80–90% trace to social determinants.
Medical coding is critical for documentation and billing. When ICD-10 was implemented in 2015, it introduced Z codes (Z55–Z65) specifically assessing social determinants of health:
| Code | Description |
|---|---|
| Z55 | Problems related to education and literacy |
| Z56 | Problems related to employment and unemployment |
| Z59 | Problems related to housing and economic circumstances |
| Z60 | Problems related to social environment |
| Z63 | Problems related to primary support group / family |
| Z65 | Problems related to psychosocial circumstances |
The pandemic dramatically amplified the importance of codes like Z60.2 (Problems related to living alone), Z60.4 (Social exclusion and rejection), and Z75.3 (Unavailability and inaccessibility of healthcare facilities). Seniors proved especially vulnerable to these risk factors.
Emerging technologies like telehealth and remote patient monitoring play an important role in addressing these social determinants. By enabling healthcare access from home, these technologies directly counteract SDoH barriers like transportation limitations, social isolation, and inability to access facilities.
Policies and programs that address social determinants of health are essential to better healthcare outcomes and an improved healthcare system. The 80–90% of health outcomes driven by non-medical factors represents both the greatest challenge and the greatest opportunity for healthcare innovation in the decade ahead.