The social determinants of health are the conditions in which people are born, grow, live, work and age.1 You’ve probably seen or read the term in headlines, presented at conferences, or discussed at roundtables and meeting, but how are social determinants of health (SDoH) relevant to pharma?
Sachin Jain MD, MBA, Former CMIO of Merck explains it this way, “Every brand needs to take a precision approach to addressing social determinants, biopharma has a huge opportunity and imperative. You can produce medicines that will change lives, but if you don’t have the living conditions to support effective use of those medicines, we’re missing an opportunity to improve human health.”
Determinants, or drivers of health, are not a novel concept, yet there has been explosion of interest across the healthcare value chain. In fact, the “aha” moment was when healthcare stakeholders realized that in order to achieve optimal health outcomes AND value for healthcare services, determinants need to be addressed.
In the shift from volume to value, understanding the complexity of patients’ lives is re-shaping drug development and commercialization. Only by analyzing data collected in routine medical care, and eventually from patients’ day-to-day lives, can pharma align with providers, payers, and regulators to design digital or traditional therapeutic interventions that will not fail in the face of complex real life.2
Studies show that there are correlations to how patients live their lives and how effective drugs are. Coupling this with arguably one of the most important determinants, health literacy, pharma has an incentive and an opportunity to address SDoH in a variety of ways. Patients from traditionally disadvantaged social groups, limited education, or income levels have struggled with medication management. Rarely does a patient not want to be healthy, yet there are other obstacles keeping them from medication adherence.3 Patients don’t wake up in the morning and think “I’m not going to follow what my doctor told me to do today.”
There are a variety of societal challenges that keep patients from taking their medications such as high out of pocket costs, mobility, inability to get to the pharmacy, limited educational attainment, and health literacy. Pharma can work with local communities to promote health by offering free transportation to and from pharmacies and doctor appointments, or working with health systems to improve health literacy in underserved communities. Prescriptions, at times, can be too difficult to access due to lack of insurance coverage, and although pharma offers substantial patient support programs, there is still systematic policy issues around coinsurance and who pays for the healthcare services and drugs used.
Social determinants such as food insecurity, transportation, job training, education, housing, and health literacy can impact clinical outcomes substantially. So who’s responsibility is it anyway to address these determinants? Well as lines of responsibility become blurred in today’s healthcare consumer-centric era, stakeholders need to work together, and take responsibility for the patient. Going beyond the pill to bundle drugs with lightweight services, whether it’s a screening, a referral or some financial assistance, are some ways pharma can address social determinants of health.
Of the determinants listed previously, many are the underlying symptoms that can lead to low rates of medication adherence. Medication adherence is and always has been a significant issue for pharma, and employing digital technologies such as apps and smart pill bottles are helping to solve this complex puzzle . Only by going a layer deeper, by learning about the true needs of the patients they are serving, will pharma truly solve this issue and improve outcomes.