Why COVID has accelerated the need for SDoH Innovation
An interview with Anant Jani by
It is by now well established that only around 30% of our health outcomes are determined by the healthcare system. The other 70% are influenced by everything else: your education, environment, lifestyle, nutrition, friendships, profession, etc. The reason why this gets us excited at FoundersLane is that this constitutes a wealth of opportunities to create healthier societies by deploying digital technologies to influence these so-called “Social Determinants of Health” (SDoH).
Our Chief Medical Officer Sven Jungmann has even co-authored a piece in the Journal of the Royal Society of Medicine, in which they argue that this can lead to what Clayton Christensen referred to as a ‘disruptive innovation’. As the research has much progressed since the publication, he spoke again with one of his co-authors and dear friend Anant Jani at the University of Oxford, who has since conducted much interesting research on the topic.
Anant is an Oxford Martin Fellow at the University of Oxford and a visiting researcher at the University of Heidelberg Institute of Global Health. He is interested in understanding how to improve population health through social prescriptions and by addressing social determinants of health. The interrelated levers his work focuses on include: value based healthcare, the strategic use of new technologies (clinical, basic science, diagnostics, IT) and impact finance/impact investing. His most recent work, in collaboration with NHS England, explores how data can be used to improve social prescribing practice in the English NHS through a learning health system approach: https://orchid.phc.ox.ac.uk/index.php/social-prescribing/
SJ: Anant, can you share with us a little about your latest activities in the field of SDoH innovation? And what do you think are the most promising innovations we should expect?
AJ: I think one of the most important aspects is the change we are seeing in how people view and think about SDoH and the increasing recognition of how important they are for health. This mindset shift is essential because it will drive behaviour and we can then view innovation using the lens of the old adage, “necessity is the mother of all invention”.
We can begin to appreciate that the innovations happening in the SDoH space are being driven by the recognition of this huge unmet need for our citizens. And the innovation is taking many exciting forms from things like the digital technologies in the form of IoT devices and digital therapeutics we covered in our JRSM piece to the use of outcomes-based contracting as well as integrating health and social care budgets to remove the silos that prevent systems from being able to address SDoH more holistically.
In the context of the COVID-19 pandemic and its aftermath, this shift in mindset and approaches to address SDoH is even more important because we know from previous systemic crises like the 2008 global financial collapse that SDoH will be at the root of what will cause our citizens to suffer.
SJ: Super interesting, what’s going on with the sentinel network you are working with? Can you share a little more about what you’ve built and what the overarching purpose of that is?
AJ: I am working with the Royal College of General Practitioners Research Surveillance Centre (RCGP-RSC) based in the Dept of Primary Care Health Sciences at the University of Oxford. The RCGP-RSC is a nationally representative sentinel network of over 1800 GP practices spread across England and covering over 8 million population. The network was set up over 50 years ago to monitor influenza outbreaks and these days, GP practices upload their full EHR data twice a week and the data is pseudonymised after being uploaded and made available for research and surveillance purposes. Through the RCGP-RSC, we have worked with NHS England to create three resources:
- The social prescribing observatory, which is updated on a weekly basis and shows social prescribing utilization broken down at different geographical levels across England and by different parameters including gender, age, ethnicity and IMD (https://orchid.phc.ox.ac.uk/index.php/social-prescribing/)
- The social need observatory, which captures 8 different social need categories based on SDoH (mental health, lifestyle-related NCDs, employment, domestic abuse, substance abuse, financial problems, homelessness, problems with parenting) broken down by the same parameters above (https://orchid.phc.ox.ac.uk/index.php/social-needs-observatory/)
- The social prescribing intervention observatory, which captures 5 specific social prescribing interventions — social prescribing for mental health, physical activity, benefits support, support for finances and arts-based interventions (https://orchid.phc.ox.ac.uk/index.php/nmi-observatory/)
Through these resources, we are hoping to provide healthcare professionals on the ground with regularly updated data that can support them in taking a learning health system approach for social prescribing.
SJ: How do you identify things like social prescribing use and SDoH from primary care electronic health records? This sounds like a massive data analytics challenge.
AJ: Yes, this was definitely a big challenge. One of the complications with building the observatories was the heterogeneity with how GPs record data. GPs use SNOMED clinical terms to capture information about patients whether it be their presenting complaints or the interventions given to them. SNOMED has a very standardised way of organising information but a complication arises because there are 10,000s of codes available on SNOMED and GPs code information in very heterogeneous ways.
For our analytics work, our biggest challenge was figuring out how GPs actually code some of the things we were looking at and determining which codes they would use. We ended up having to spend a lot of time trawling through the SNOMED database to identify SDoH-related codes. For our social needs observatory, there are actually hundreds of codes sitting behind those 8 categories.
SJ: From my perspective, interventions geared towards social determinants of health, are still very much in their infancy. What do you think needs to happen to really allow us to influence SDoH at scale?
AJ: Well, as mentioned earlier, we have to continue supporting leaders, decision-makers and innovators with the knowledge to help them shift their mindsets and realise the important role SDoH play in promoting health. When thinking about health, we need to think beyond the healthcare system and we must move beyond the silos we are normally used to working within if we hope to address SDoH systematically.
This is easy to say but very hard to do because of the complexities and intersectionalities inherent in SDoH. But I am hopeful. Mindsets are shifting. The COVID-19 pandemic has been devastating but it has also driven new ways of thinking and has given us the opportunity to address SDoH in its various forms. New and more progressive policies to tackle SDoH are being discussed, designed and, in some cases, being implemented.
We are seeing more discussion and implementation about different types of financial, contracting and operational arrangements, including care pathways like those integrating social prescriptions, that would support more holistic ways to tackle SDoH. And we are also in a stronger position now to help change and support healthier behaviours at an individual level through technology in the form of IoT-based sensors and wearables, gamification, etc.
One thing to note with all of this is that the notion of needing to address SDoH is not new. Rudolf Virchow actually started talking about this in the mid-19th century to address the fallout resulting from the industrial revolution. And great strides were made because of the efforts of people like him and the proof is in fact that health in European countries has dramatically improved since the mid-19th century and even the early 20th century.
In the 21st century, we are facing new challenges to our health but I am confident that we will be able to tackle our current problems as well to improve the health of our populations.
SJ: What is the one thing that you wish you knew before you started going into the field of SDoH?
AJ: The complexity. This stems from the fact that every category of the actor within our systems (e.g. public sector, private sector, not for profit sector and individuals themselves) has an essential role to play in addressing SDoH as well as in perpetuating the imbalances that lead to inequalities and adverse health outcomes when they are not addressed properly.
If you want to know more about FoundersLane’s approach to Corporate Venture Building in healthcare, feel free to contact Sven, or read our new book Das Entscheidende Jahrzehnt and start receiving our newsletter today.
The interview was conducted by Dr Sven Jungmann.
Dr Sven Jungmann is a doctor-turned-entrepreneur. He is a partner at FoundersLane and an advisor to health start-ups and investors. Handelsblatt listed him among Germany’s smartest innovators. Sven has consulted Wellster Healthtech, the D2C health success case in Germany and continues doing so via an advisory board role. Wellster Healthtech has been promoting D2C in health early on.
FoundersLane, the leading Corporate Venture Builder for climate and health, was founded in 2016 by Felix Staeritz, Andreas von Oettingen, and Michael Stephanblome. The team develops digital business models in the health and climate sector by combining the agility and the mindset of technology entrepreneurs with the strength of corporations. FoundersLane draws on more than 20 years of experience by the founders in building up new companies.
FoundersLane creates new, fast-growing digital companies in categories that are highly topical and current. FoundersLane counts more than 100 founders, experts and entrepreneurs with great expertise in the fields of medicine, health, climate, disruptive technologies such as IoT connectivity, AI, and machine learning. Clients and partners include SMEs and corporations as well as more than 30 Forbes listed companies, such as Trumpf, Vattenfall, Henkel and Baloise. FoundersLane is active in Europe, MENA and Asia with offices in Berlin, Cologne, Vienna and London.
