Health Care's Blind Side: Unmet Social Needs Leading To Worse Health

    • December 7, 2011

In a new, national survey, physicians say unmet social needs — like access to nutritious food, transportation assistance and housing assistance — are leading to worse health for all Americans.

As our nation grapples with increasing poverty, joblessness and homelessness, these findings provide new insights into what it takes for Americans to get and stay healthy.

"America’s physicians understand that our health is largely determined by forces outside of the doctor’s office. Housing, employment, income and education are key factors that shape our health, especially for the most vulnerable among us,” said Jane Lowe, team director for the Vulnerable Populations portfolio of the Robert Wood Johnson Foundation. “Physicians are sending a clear message: The health care system cannot continue to overlook social needs if we want to improve health in this country.”

This study was conducted online by Harris Interactive on behalf of the Robert Wood Johnson Foundation between September 16 and October 13, 2011 among 1,000 physicians, of which 690 were primary care physicians and 310 were pediatricians. Key findings from the survey include:

  • Four in five physicians surveyed (85%) say unmet social needs are directly leading to worse health for all Americans.
  • Four in five physicians surveyed (85%) say patients’ social needs are as important to address as their medical conditions. This is especially true for physicians (over 9 in 10, or 95%) serving patients in low-income*, urban communities.
  • Three in four physicians surveyed (76%) wish the health care system would cover the costs associated with connecting patients to services that meet their social needs if a physician deems it important for their overall health.
  • Only one in five of physicians surveyed (20%) feel confident or very confident in their ability to address their patients’ unmet social needs.
  • Physicians surveyed reported that if they had the power to write prescriptions to address social needs, these would represent one out of every seven prescriptions they write** — or an average of 26 additional prescriptions per week.

If physicians were able to write prescriptions for social needs, they would frequently prescribe fitness programs, nutritious food and transportation assistance. Physicians whose patients are mostly low-income would write prescriptions for pressing needs such as employment assistance, adult education and housing assistance.

These survey results echo a growing body of research that shows today’s health care system and its focus on treating medical conditions neglects the significant role that social needs play in the health of Americans. Research has shown that factors such as education, income and place of residence can play a greater role in determining people’s life expectancy than health care. Studies also link social factors such as inadequate housing, employment, access to food and other neighborhood deficiencies to more frequent emergency room visits, hospitalizations and overall poorer health, which strains the health care system.

"Every day in America, a physician prescribes medication to treat people’s medical conditions when the larger health issue might be that they live in their car or are without enough food to eat at home. If we are serious about improving the health of all Americans and reducing the cost of care, we have to address patients’ social needs,” said Rebecca Onie, chief executive officer and co-founder of Health Leads. Health Leads, a grantee of the Robert Wood Johnson Foundation, enables physicians and other health care providers to prescribe basic resources, such as food and heat, for their low-income patients, and is one of many promising models addressing social needs through the health care system.

Download the survey findings and recommendations.

Survey Methodology
Harris Interactive®, on behalf of the Robert Wood Johnson Foundation, conducted the survey online within the United States between September 16 and October 13, 2011, among 1,000 physicians, comprising 690 primary care physicians and 310 pediatricians. The sample source was the American Medical Association Masterfile and based on those that agreed to be invited to participate. The participation rate was 5 percent; 1,000 physicians completed the survey out of 200,000 invited to participate. The sample was pulled randomly and results from the physician survey were weighted as needed for region, age and gender. Because the sample is based on those who agreed to be invited to participate, no estimates of theoretical sampling error can be calculated. Refer to the survey for a full methodology, including weighting variables.

* For purposes of this survey, low-income communities are defined as those in which at least 50 percent of patients belong to a household with an annual income of less than $50,000.

** This number was calculated by dividing the average number of prescriptions physicians would write for social services if able (26) by the sum of the average number of prescriptions physicians currently write (or medications they dispense) in a week (150) and the average number physicians would write if able (26).