Determinant (noun): a factor which decisively affects the nature or outcome of something; serving to determine or decide
Why are things the way they are?
As a strategist, it is often my job to identify leading factors influencing outcomes. I do this typically to help a group of people – a nonprofit organization or a company – come up with a set of activities to influence those factors to create a more favorable outcome. So as a rule, I’m usually trying to pick apart the underlying drivers of outcomes.
This can make it difficult to be around me sometimes. I am accused of making leaps of logic when really I’m just playing out scenarios in my head. And while that works pretty well when playing board games, it can get a little annoying half-way through a movie.
Some of this is about intuition and ‘a gut feeling,’ but most often it is a function of data. And when it comes to the underlying drivers affecting disinvested communities, the data is pretty clear – the deck is stacked against people experiencing poverty. Following more than two years of the pandemic, these factors have never been more pronounced or wide-ranging. That is why we’ve taken to calling it ‘the social determinants of everything.’
Risk Factors Influencing Health
If you are familiar with the term ‘social determinants,’ it is likely through its connection to health. The concept of the social determinants of health (SDH) existed more than 100 years before the World Health Organization’s Commission on Social Determinants of Health convened in 2005. The resulting report focused on the social factors that lead to ill health and health inequities globally.
One of the oft-quoted statistics from the report is that activities inside a clinical setting, like at a doctor’s office or hospital, only account for 20% of one’s health outcomes. Fully 80% of what influences a person’s health are factors unrelated to receiving medical care – things like food access, housing, education and environmental factors. As an example, if someone has mold in their home, that person will continue having respiratory issues a physician can only do so much to address.
SDH are a big part of the future of healthcare in America and are essential for driving down the cost of healthcare, particularly for disinvested populations. As Medicaid undergoes transformation in North Carolina to a managed care model, health systems are working to drive more community-based approaches that attempt to work upstream of health complications, tackling preventative care that avoids costly health interventions that lead to poor outcomes. It represents a costing model that aligns with the best interests of patients.
In short, we can’t just focus on healthcare if we want people to be healthier. We have to look at the whole picture, to understand that there are other factors affecting health. It requires thinking outside of silos.
It means talking about systems.
Determinants vs. Drivers
Some have begun using the term ‘social drivers’ instead of ‘social determinants,’ or else use them interchangably. A recent report by Ann Somers Hogg with the Christensen Institute makes a strong and well-reasoned argument for replacing the term ‘determinants’ with ‘drivers.’
Determinants do suggest a pre-determined path based on a set of factors. We stand behind the phrase ‘social determinants’ because systems have been built and perpetuated that produce these outcomes – they are not merely drivers but social constructs. Many of the risk factors that lead to poor health outcomes are the same for educational success, employment and economic mobility. And the reality is that many of these factors are driven by systemic frameworks.
That is not to say that self-efficacy is not a significant influence on outcomes – it is the most important factor determining an individual’s success. But it would be unfair to lift up individual achievement in the face of such overwhelming odds and suggest that the underlying social factors that made it so difficult were just part of the equation. It shouldn’t be this difficult, and acknowledging that decisive factors were in place makes that achievement all the more significant. And too rare.
As we take stock of not only our community but the global consequences of the recent pandemic, we can see that a myriad of pre-conditions led to a weakened system of care and slow responses. We can see how everything is connected.
We’ve written about this before, this notion of overlap and ‘mutuality.’ With COVID-19, we now understand how community health affects commerce, for example. We can see the complexity of the systems in which we operate and how every social issue has a likelihood to impact you personally – your family, your work and your community.
Today, we’re asking you to apply that same understanding of mutuality to those who are least well-positioned to thrive when times are tough. If the factors influencing your own success over the last 2+ years were complicated and layered, can you fathom what it must be like for someone experiencing poverty even in the best of times?
The Future of Mutuality
At Next Stage, we believe we are at an incredibly important juncture in history. Our recent experiences as a society have the potential to create a rare moment of empathy. Not only can we see ourselves in the struggles of others, we also have had a glimpse behind the curtain and know that our systems are fallible.
What will we do with this knowledge? Of late, we have noticed in some a desire to ‘get back to the way things were’ before disruption was a part of the daily grind. This is a missed opportunity to use our newfound empathy and systemic awareness to rebuild stronger and more equitably. But to do that, we’re going to need to address some things:
Increased Collaboration – We all need to be working together, now more than ever. Nonprofits accustomed to operating in a sector like health, education or housing need to see that other program providers are not just creating wrap-arounds on your programming – their work is as important as your own. But nonprofits are just the most visible frameworks for collaboration. The much bigger need is for our municipalities to work in concert with the private sector to get to the root causes of inequity. Nonprofits, government and businesses have never been more aligned than in the climb back from the pandemic – it is time to demonstrate a new model in practice.
Stronger Advocacy Efforts – It has been amazing to see the repositioning of advocacy in society. Everywhere you look, efforts to drive ‘community voice’ and ‘trust-built philanthropy’ have renewed energy and context. Institutions that may have seen ‘flexing their voice’ as a risk are now building advocacy plans, and it heartens us at Next Stage. We believe this moment of empathy and system awareness will fade if it is not kept alive through advocacy efforts. We cannot afford to forget what we have learned together and we need more human-centered ways of unpacking how our systems create the inequity we are committed to overcoming.
Investment in Data & Analytics – The overlapping factors influencing someone’s success are myriad and complicated to map. As a people, we prefer simple equations that make it easy to understand how to move forward. A general lack of real-time data and analytics is partly to blame, with disconnected databases throughout our community unable to build a more complete picture for us all. We are living at a time of incredible computing and data access – it is time we pointed that innovation at helping us understand how these risk factors are linked.
Last year, we rebranded our firm ‘to work at the intersection of social good.’ The concepts of mutuality and social determinants suggested that our narrowed focus on strategy for nonprofits was only one part of the bigger story. That realization, a growing one over our eight years as a firm, led to an important juncture – either we accept it or do something about it. We chose the latter, and it has led to a new journey for us as a firm and for me as a professional. I’ve never felt more determined and purpose-driven in my life.
How have you been affected by all that we’ve learned together? How is it changing how your nonprofit, company or municipality operates? Are you similarly feeling called to ‘a different way of being?’
I sure hope so. The future of many people is depending on it.
An Essay from Josh Jacobson