SDOH: How economic stability affects access to care

Many older Americans face difficulties when accessing the health care system as they age. Social Determinants of Health (SDOH) are the conditions in the environment where people are born, live, learn, work, play, worship, and age. They affect a wide range of health, functioning, and quality of life outcomes and risks, and are a key focus within the Healthy People 2020 and 2030 reports recently released by the U.S. Department of Health and Human Services.

Each decade, this government report sets the nation’s objectives to improve health in the U.S. SDOH assesses the resources that are available to you in homes and communities. There are five components:

1. Economic stability

2. Education

3. Social and community context

4. Health and healthcare

5. Neighborhood and built environment

Each of these five aspects of SDOH affects quality of life which, in turn, affects health. For example, growing up in a neighborhood that does not have access to affordable nutritious foods can lead to obesity, heart disease, and diabetes. Or, what if a neighborhood does not have access to public transportation? Patients may miss important doctors’ appointments, ultimately leading to poor health outcomes.

Where we live and work may contribute to health disparities or differences in health between groups of people that are often related to social and economic factors. This can lead to health inequity where various communities may not have the same access to healthcare or health resources. Consequently, inequity like this can lead to lower life expectancy and poorer health.

The Robert Wood Johnson Foundation states that “good health begins in the places where we live, learn, work and play. Although medical care is critically important, things like the quality of our school, affordability, and stability of our housing, access to good jobs with fair pay, and the safety of our neighborhoods can keep us healthy in the first place.”
 

Economic stability

According to the CDC, economic stability is not how much money an individual has, but whether they have the resources to afford housing and food. As employment income slows and eventually stops, we rely upon other sources for basic living expenses. Sometimes that money is not enough to meet day-to-day expenses or runs out when extra expenses occur. Under the SDOH component of economic stability there are four topics:

1. Employment

2. Food insecurity

3. Housing instability

4. Poverty
   
   

Employment

It is important to have a safe and stable working environment. Employment ensures income. With income, we can afford housing and food. Many people also receive health insurance from their employers. As we age, many people are no longer employed and rely on alternative income of savings, social security, and Medicare benefits. If we have low income from these resources, this can lead to food insecurity, housing instability, and poverty.
 

Food insecurity

Low-income neighborhoods that do not have access to nutritious foods are called food deserts. They are often far from supermarkets or have stores where nutritious foods are high-priced. If foods are unavailable or expensive, this can lead to food insecurity, defined as not having enough nutritious food for healthy living. Food deserts often have a high rate of hunger, obesity, heart disease, and diabetes.

For aging adults who may not be able to access foods due to lack of money and transportation to markets, food insecurity can lead to poor wound healing, chronic illnesses, and malnutrition.
 

Housing instability

Affording the rent or mortgage is only the beginning of the many expenses involved with keeping a home. For those on a fixed income, the cost of maintenance, repairs, taxes, and utilities can mean that home upkeep is often delayed, or even goes undone. Allowing home maintenance to lapse may lead to unsafe living situations for seniors.

Moreover, an increasing number of seniors are unable to afford housing at all, and instead turn to shelters. According to the Annual Homeless Assessment Report (AHAR) to Congress reported 67,000 adults 62 years of age or older were living in homeless shelters in 2016. It is predicted that over the next decade, the number of elderly homeless Americans will triple. Homelessness is often associated with high rates of alcohol and drug abuse, high rates of infections, and worsening physical and mental illness.
 

Poverty

As we age, the fixed income of social security and savings often cannot keep up with the increased inflation and costs of living. According to the U.S. Census Bureau, American Community Survey, 4.7 million Americans over 65 years old, or 9.4%, lived in poverty in 2019. This percentage increases dramatically as that population ages and depletes their available savings, with 13.6% of women aged 80 or older living in poverty. Lack of financial resources can restrict the ability to afford even basic medical care, leading to potential complications of preexisting conditions and poor health outcomes. The combination of increasing chronic medical conditions, increased number and cost of medications, and more hospital admissions, with less available funds to spend on medical care is a deadly combination for seniors. 

What type of programs are available?

Fortunately, resources exist to help seniors manage their day-to-day expenses. These programs are government-funded and accessible to qualifying seniors. Patients can reach out to their health plans about eligibility and for more information.

1. Social security benefits. The national average for a retired worker is $1,514 a month. Spouses who have never worked are still eligible to receive 100% of their late spouses’ benefit if they reached full retirement age before claiming their Social Security Benefits. The amount would be lower if the working spouse retired early.

2. Supplemental Security Income (SSI). A supplement for those on Social Security with a disability and limited other resources.

3. Medicare: Governmental health insurance is available to all adults 65 and older.

4. Medicaid: Those receiving Medicare may also qualify for additional assistance to pay premiums and out-of-pocket expenses.

5. Affordable housing: US Dept of Housing and Urban Development provides affordable housing resources for older adults.

6. Nutritional support: The Supplemental Nutrition Assistance Program and other programs are available to support older Americans suffering from hunger and poor nutrition.