The Relationship Between Chronic Disease Management And The Social Determinants of Health

Individuals with chronic diseases often have unique care needs that can span across different programs and providers, creating challenges when managing care. In addition, chronic disease management is significantly more difficult for patients who are facing economic hardships that make it difficult to secure basic needs. A research team headed by Seth A. Berkowitz, MD, MPH, from Massachusetts General Hospital surveyed 411 patients to better understand the relationship between chronic disease management and the social determinants of health. According to the Center for Disease Control, the Social Determinants of Health include:

  • Chronic Disease Management And The Social Determinants Of HealthSocioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
  • Availability of resources to meet daily needs (e.g., safe housing and local food markets)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Transportation options
  • Public safety
  • Social support

In this study, Dr. Berkowitz illustrates that patients with multiple economic concerns were more likely to report poor control of their chronic disease while accessing more costly outpatient healthcare services. Many of the patients reported more than one economic hardship, including 19.1% experiencing food insecurity, 10.7% reporting housing instability, 14.1% with energy insecurity, and 39.1% stating they could not afford at least one basic material need. More than a quarter admitted that they were non-adherent to their medications due to cost. Among the same patient population, 46% were found to have poor diabetes control.

The study concluded that “Health care systems are increasingly accountable for health outcomes that have roots outside of clinical care. Because of this development, strategies that increase access to healthcare resources might reasonably be coupled with those that address social determinants of health, including material need insecurities.” This shift towards collaboration between healthcare and social service providers is good news for both providers and patients. Addressing the social determinants of health as part of a whole person treatment plan has the ability to improve health outcomes for the patient, while also controlling the system costs associated with poorly managed chronic illness.

For more information about Dr. Berkowitz’s study, please see

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