5 Questions and Answers: Drivers of Health and Behavioral Health Outcomes

Drivers of health lead to intergenerational disparities that negatively impact behavioral health outcomes and accessibility. Behavioral health providers can better address health equity using technology such as an Electronic Medical Record (EMR) to increase the quantity and quality of available health data in underserved communities. Moreover, medical professionals and policymakers can use EMRs to identify community needs and inform policies that lead to lasting improvements. Talk To Our Experts

The drivers of health (DOH) are key indicators of the overall well-being of a community. When analyzed in conjunction with specific data, they can identify communities and demographics that have an increased need for intervention and behavioral health services. This is the power of data. When used effectively, it can inform interventions that have the potential to improve community health outcomes for current populations and generations to come. Here are five key questions that shed light on how behavioral health providers can analyze these drivers to develop a macroscopic view of problem areas and support the implementation of overarching strategies that promote access to healthcare and optimal health for underserved and disadvantaged populations.

1. What are the drivers of health and health equity?

The drivers of health are the social, environmental, and economic factors that affect the health of a community. Using DOH as a model for understanding health equity started in the 1970s when the CDC began examining how poor health outcomes were linked to factors like education, income level, and race. Today, it is understood that social disparities lead to physical and behavioral health problems, including a high incidence of substance use disorders, in communities with restricted access to quality medical and behavioral healthcare. The most common social determinants for health equity include:

• Income level
• Level of education
• Access to quality healthcare
• Safe housing
• Healthy food and food security
• Job opportunities
• Neighborhood crime levels
• Social attitudes

The drivers of health correlate positively to health outcomes in a community. In areas where social, environmental, and economic factors create a lower standard of living, people are more likely to be sick. According to the Centers for Disease Control and Prevention, health disparities lead to behaviors and higher rates of disease among underserved populations, including:

• Cancer
• Chronic diseases
• Oral health
• Obesity
• Tobacco use

Health disparities in these key areas lead to increases in morbidity, mortality rates, healthcare expenditures, and functional limitations. Therefore, it can be determined that working toward health equity requires addressing the drivers of health and providing solutions that result in improved health among members of a community. A large part of this responsibility falls upon healthcare providers. Healthcare facilities must consider and work to mitigate the unique challenges faced by communities impacted by health inequality. Healthcare providers are in the unique position of accessing valuable medical data that can be used to inform policies and influence public health. They also have the ability to use data and analytics to drive policy and investment that will further every person’s ability to achieve their full health potential, regardless of race, gender, sexual orientation, and other social circumstances.

2. How do the DOH impact behavioral health outcomes?

Researchers from Massachusetts General Hospital and Harvard Medical School note that health inequality leads to a greater risk of developing a mental health disorder, and it results in reduced access to the healthcare services needed to support mental health concerns, such as substance use disorder. In addition to increased risk, drivers of health lead populations to experience the impact of mental health disorders more acutely. Factors such as a person’s physical environment can lead to a higher incidence of severe illness. All these factors combine to impact a population over generations, forcing a community into a generational cycle of undertreated medical and mental health conditions. “A two-way relationship exists between mental health disorders and social determinants, as poor mental health can aggravate personal choices and affect living conditions that limit opportunities,” the researchers wrote. The need for mental health services, combined with a lack of accessible and affordable care, results in a significant economic impact. Health disparities directly affect the national cost of medical and mental healthcare across every category, leading to $93 billion in medical costs and $42 billion in lost productivity per year. Data from electronic medical records (EMR) show that high-cost behavioral health patients are more likely to have a documented history of mental health conditions that include:

• Anxiety
• Depression
• Major psychosis
• Personality disorders
•  Other psychiatric conditions

EMR data for high-cost behavioral health patients also points to a higher incidence of adverse childhood experiences (ACEs) and higher rates of specific adverse childhood experiences and household dysfunction, such as substance abuse. Research shows that drivers of health have a direct and immediate bearing on behavioral health, rates of substance use disorders, and the increased need for behavioral health services in communities negatively impacted by the drivers of health. When these needs are not met, behavioral healthcare costs continue to rise.

3. How has COVID impacted health equity?

COVID-19 has had a significant impact on health equity. Research shows that disadvantaged communities were disproportionately affected by the social and economic impact of the pandemic. The Kaiser Family Foundation notes that “data consistently show that American Indian and Alaska Native (AIAN), Black, and Hispanic people have experienced disproportionate rates of illness and death due to COVID-19.” In addition to the direct health consequences of the virus, mental health has been influenced by the social changes inherent in the nationwide response to the virus. Before the pandemic, one in ten U.S. adults reported experiencing symptoms of anxiety or depression. But beginning in June 2019 and coinciding with wide-scale lockdowns, the number of U.S. adults experiencing anxiety and depression rose to 4 in 10. These increased rates of depression appeared more frequently in communities of color. Data also show that non-Hispanic Black adults (48%) and Hispanic or Latino adults (46%) report anxiety and depression more frequently than non-Hispanic White adults (41%). These numbers reflect the difficulty in accessing mental healthcare in communities of color.

4. How can we address DOH and achieve health equity within behavioral health?

Addressing the drivers of health and increasing health equity in the field of behavioral health begins with data. Thanks to the nature of their work, behavioral health providers have access to data that can inform policies and protocols that can lead to lasting change. Behavioral health providers can be encouraged to adopt EMRs to facilitate data collection. Quality behavioral health data collection software can increase the amount of data collected and ensure the integrity of that data. EMR adoption can also facilitate secure data sharing so that the insights gleaned from local data can be used by policymakers to drive change.

Leaders in behavioral health can also facilitate a greater level of coordinated care across behavioral health and primary healthcare fields by adopting innovative models such as:

• Coordinated care organizations (CCOs)
• Accountable care organizations (ACOs)
• Managed care organizations (MCOs)

The creation of payor models such as value-based care strategies can also address health equality on a policy level, further improving mental health outcomes through affordable services. Finally, health equity can be achieved by addressing the drivers of health that cause the disparities among advantaged and disadvantaged populations. The National Alliance on Mental Illness (NAMI) outlines four key ways to support community health for long-term improvements. NAMI’s community guidelines include creating:

• Economically integrated neighborhoods and affordable housing
• Green spaces for exercise and socialization
• Increased neighborhood cohesion through community centers and gardens
• Access to healthy food

Actioning strategies from the bottom-up by altering DOH and top-down by utilizing data for an overarching view of where efforts should be applied, we can ensure that all aspects are accounted for in a comprehensive effort to change the landscape of health equity.

5. What role does data play in health equity?

Effective collection, extraction, analysis, and sharing of data can help providers begin to address specific drivers of health, making quality behavioral health services accessible to all people, as the Centers for Medicare and Medicaid Services suggests, “regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” This can bring positive long-term consequences such as improved outcomes across communities and generations and reduced behavioral health costs. Behavioral health providers can achieve this by using electronic medical records to capture data for the most pressing DOH factors impacting a community. The snapshot afforded by this data is gained by collecting information related to:

• Race
• Socioeconomic status
• Ethnicity
• Literacy
• Social barriers

Taken as a whole, EMR data can identify and address the chief health drivers in a community, allowing providers to foster health equity. Behavioral health leaders must be willing to acknowledge that these health disparities exist and actively do the work of tracking such critical data. When behavioral health providers make this valuable data accessible, they can inform policy that allows for effective, long-lasting improvements. Sunwave Health is a software company that provides solutions for effectively managing all aspects of behavioral healthcare data. Contact us today for more information on how Sunwave Health can help your behavioral health facility harness the power of data to support the populations most in need of your care.