Editor’s Memo

The Dark Side of SDoH

Peter Wehrwein

Addressing the social determinants of health has become fashionable in American health care, which loves a hot trend almost as much as it does new technology or promises to rein in spending.

The ambition makes sense: Move upstream (and out of the office and away from the hospital) to where the causes of illnesses are rooted and attack them there. And among those who already have an illness, make sure those diseases stay properly managed and treated. Many of the innovations discussed in this issue are animated and informed by this keen interest in social determinants of health.

But last month, Marshall Allen, a reporter at ProPublica, referred to social determinants of health as a “jargony phrase” used by salespeople. He painted a far less flattering picture. Some insurers are using socioeconomic data to help people get appropriate care, wrote Allen, but he also talked to experts who see a real danger of discrimination if that data is used to price coverage, particularly as ACA protections get chipped away.

There are also privacy concerns. Allen spoke with a former Aetna employee who described a company effort to merge data on hobbies and habits with more traditional health care information. “It was a data set that really dug into our clients’ lives,” she told Allen. “No one gave anyone permission to do this.” Aetna responded with a statement that said the information helps the company reach out to members and plays no role in underwriting.

A few days after Allen’s story was published, MedPage Today’s Cheryl Clark wrote about SDoH-related algorithms undercutting the physician–patient relationship and not living up to the hype.

Maybe an SDoH ounce can be worth more than a pound of ED visits, hospitalizations, and expensive care by specialists.

But there’s potentially a dark side to all of this, which if not held in check will make SDoH seem like a unethical ploy rather than something that Ben Franklin would have approved of.


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