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Study: Focus on social factors to tame obesity, curb health spending

Anjalee Khemlani
Senior Reporter

Health care should address “social determinants” like income, housing and food in a wide-ranging effort to curb health spending and tackle weight-related illness, a new report published said on Tuesday.

According to a PwC study, soaring rates of obesity are forcing governments to spend more than ever on health care, to the tune of $8.4 trillion annually. Even though the world is wealthier, the population is growing sicker, PwC noted, with rates of cancer, cardiovascular disease and diabetes all spiking.

Because health care is focused largely on high costs of services provided, and drugs that treat some of the rarest or more chronic diseases, the report suggested countries could achieve better results by homing in on behavioral factors that would result in a less sickly population.

“Curing disease may seem more within reach than curing the underlying societal challenges of poverty, hunger or unemployment. But the increase in illnesses caused by people’s behaviors and where they live and work could suffocate public and private budgets in both wealthy and poor countries,” PwC’s analysts wrote.

“More important, our research and work in the field has led us to conclude that it is, in fact, possible to quantify the benefits and investment returns of an alternative approach that targets social factors,” it added.

Going in the wrong direction

Social determinants is an increasingly popular phrase in the global discussion about lowering health care costs. The idea centers on environmental factors that influence what people eat — and where and how they live.

The movement has found legislative support in the U.S. Congress, which recently introduced a bill calling on Health and Human Services to establish a council to address the issue.

Cans of soda are displayed in a case at Kwik Stops Liquor in San Diego, California February 13, 2014. REUTERS/Sam Hodgson (UNITED STATES - Tags: POLITICS FOOD HEALTH)

In 2017, nearly 12 percent of U.S. households were food insecure at some point during the year, according to the U.S. Department of Agriculture. However, the discussion has yet to gain any real headway in the discussion about America’s health care.

“Things aren’t going in the right direction anymore,” Benjamin Isgur, managing director of PwC's Health Research Institute, told Yahoo Finance.

“The answer to this is not to throw our hands up,” PwC’s Isgur said. “We have to step up and say if our purpose is to make people more healthy, then we have to think about revamping the structure and rerouting the money.”

PwC’s study called on stakeholders at various levels within the health ecosystem to collaborate, establishing a data-based framework based on “the reality of how people live and work.”

The firm’s study cited findings from England and Australia, where a focus on social factors has generated optimism about health care spending.

The Atrium example

In the U.S., a number of pilot research programs have done the same, with Atrium Health, in North Carolina, just one example.

The hospital system asked the community what they needed in the zip codes they saw the most emergency visits from. From that initiative, Atrium created a “food pharmacy” by partnering with the largest local food pantry.

“We engaged at a local and county level,” Alisahah Cole, chief community impact officer at Atrium, told Yahoo Finance in a recent interview.


Even with the rise in pilot programs, the movement to emphasize social factors is lacking in data. However, research over decades has shown that “what impacts health the most happens outside of clinical walls,” Cole said.

“It took an entire year to do this work, and talking to patients and community members, private businesses, education partners and non profit partners,” she added. “We wanted to be intentional about that because we wanted the priorities to come form the community and be community-driven.”

PwC’s Isgur also noted the relative lack of political will to tackle behavioral and environmental changes that would lead to a shift in health care.

Yet “whenever you have something that is a long term interest to society, you have to figure out how to have it transcend politics,” he said.

The firm’s report issued a broad call to arms among all stakeholders, including community and non-profit groups, to create a robust framework — even though the payoff may not be seen “for years.”

Isgur added that “if you want to move the needle with nontraditional health care players with technology and financial companies, you have to speak a language that everyone understands.”

Anjalee Khemlani is a reporter at Yahoo Finance. Follow her on Twitter: @AnjKhem


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