The Social Determinants of Health (and well-being)

Later this month, I plan to attend a national convening about how we here in the US could move from focusing on purely economic indicators like GDP to outcome measures that better account for the overall well-being of individuals, families, and society. Economic opportunity and stability are critical to health and well-being, but there is so much more that people need in order to succeed and thrive. 

While this seems like common sense, policy sometimes hyper focuses on just one specific area of people’s lives, ignoring everything else, as if each aspect of people’s lives exists in a vacuum.  

For example, in healthcare policy, it’s tempting to just focus on improving access to high quality, affordable healthcare as the way to improve health outcomes. But people’s mental, physical, emotional, and spiritual health are also dependent on so many other factors, like people’s built environment, access to education, financial stability, and connections to family, culture, and community. How hard is it to maintain or improve health if you don’t have reliable shelter, or if you have lead in your water, or if you don’t have the gas money to make it to your healthcare appointment? 

In the health policy world, we refer to these other factors that impact health as the “Social Determinants of Health,” which is really just a fancy way of saying that people have many, interdependent needs that have to be met in order to thrive. 

What’s exciting is that this shift to thinking about the Social Determinants of Health is now leading to actual changes in policy and practice. For instance, the State of Oregon, where I live, recently received approval of its 1115 waiver for Medicaid. An 1115 waiver allows States flexibility to design and improve their programs in ways that will likely assist in advancing Medicaid program objectives, like improved health outcomes. Oregon’s 1115 waiver notably includes funding to address inadequate food, housing, and other root-cause issues that lead to poor health. 

This funding creates opportunities to help fill in some of the gaps in support that currently exist for people, especially for populations in transition, like children leaving foster care, to make sure they have what they need to successfully move on to the next stage in their lives. 

Health policy shouldn’t be the only area where we consider better supporting the whole needs of people, families, and communities. In the policy area of retirement security, we need to also recognize how inextricably linked financial wellbeing is to other aspects of people’s lives, including health. After all, 66.5 percent of all bankruptcies in the US are tied to medical issues. It’s hard to save enough for retirement if you have to pay off crippling medical debt, or your job doesn’t pay a living wage in the first place, or you can’t attend trade school to earn a higher wage, because you can’t find affordable child care. 

We’re going to need to come together collectively, across sectors both public and private, to really move the needle in terms of overall outcomes for people. The change in focus to people’s whole well-being helps open the door to that kind of overall systems thinking and the potential for more collaboration between parts of government, community, and the private sector, which each have important roles to play in supporting what people need.

Columnist and Senior Associate Joel Metlen is based in Oregon. Joel is a pioneer of the state facilitated retirement savings space, woven into a career of public service and innovation. At OregonSaves, Joel’s responsibilities ranged from marketing and employer engagement to operations and data analysis. You’ll see his insights from that experience, and more, here.

This piece was featured in the November 17, 2022, edition of Retirement Security Matters. For more fresh thinking on retirement savings innovation, check out the newsletter here.