The social drivers of health - why housing, education and more are important

When we hear the word "health" we often think of doctors, nutrition and exercise, but there's so much more that contributes to a person's overall wellness. Social drivers (also referred to as social determinants) of health are key indicators that play an important role in a person's health.

"When we talk about social drivers in health care, we're talking about those environmental conditions where people live, work and play that can influence overall health outcomes," said Ann Oshel, head of Community Health and Well-Being at Alliance Health. Alliance Health is a managed care organization for public behavioral health that serves Wake, Durham, Cumberland and Johnston counties. "This new direction in health care is about addressing people's complex health needs in the complex environment in which they live. It's an attempt to build bridges between healthcare and social services."

Some examples of social drivers are:

Oshel, who has worked in mental health for more than 30 years, explained that it's hard, for example, for someone to stay on a medication if they're homeless and living under a bridge, or for someone to see a doctor if they're in an abusive relationship.

"Taking social drivers into consideration is nothing new for us at Alliance Health. We've been thinking about holistic care for a while and we've been funding access to things like supportive housing," Oshel said. "We are also addressing transportation barriers – paying for transportation to places like pharmacies or delivering groceries. We're seeing great outcomes with these services."

"We work to build on the strengths of individuals and families, improve access to services, and create valuable partnerships with community organizations that support well-being and recovery," explained Doug Fuller, director of communications at Alliance Health. "We pursue this mission in a variety of ways through our efforts in reducing the stigma of mental health issues or addiction through education and health literacy, unique health and housing programs, and initiatives like Hope4NC, a crisis counseling program for hurricane survivors."

Fuller added, "One of our most externally recognizable efforts is that we help people secure affordable housing through our partnership with the Durham Housing Authority to secure specialized vouchers for chronically homeless individuals."

Chronically homeless individuals are people living with a disability who have experienced homelessness continually for one year or more, or who have at least four episodes of homelessness in the last three years that total 365 days or more.

Tim Weaver was living under a bridge on Fayetteville Street in downtown Durham when Alliance Health helped him secure permanent housing through its Durham Area Supportive Housing Program, which is funded by the Department of Housing and Urban Development.

"Our program houses approximately 33 people in about 14 households where we provide permanent supportive housing, which means we provide a rent subsidy in addition to ongoing intensive case management to support people in maintaining their unit, and developing and growing towards self-sufficiency," explained Malcolm White, tenancy support coordinator at Alliance Health. "Several people in the community were aware of Tim and his situation. He was someone that we knew really needed this program's help."

Weaver, who suffered a stroke and is dealing with cancer, was given the keys to his own place in September.

"The house helps me out a lot — I was sleeping under a bridge, even in the snow," Weaver said. "I love that I have my own privacy and I'm not worried about somebody pulling a knife on me or hitting me with something [during the night]. I've been robbed — different stuff people wouldn't believe."

Weaver also gets helpful reminders about his medical appointments and assistance with transportation to and from these appointments. White emphasized what a huge impact stability can have on a person's overall health.

"Social drivers like housing can mean everything in terms of maintaining quality of life and behavioral health. It's pretty difficult to ask someone to maintain an outpatient appointment if they don't have a reliable place to sleep every night or if they have to figure out a new bus route every single time," White said. "Having four walls where you get to decide who you want to be inside of those and how you want to live just like every other person does — that should be a right for people, not a privilege."

When asked how he felt about others who are still in the same homeless situation that he once was, Weaver got emotional.

"I feel sorry for them," Weaver said. "Just the other day, someone was holding up a sign and said he was hungry. I had one sandwich [that I shared with him]. I've seen a lot. But having a place to live — I don't have to worry about that now, thanks to Alliance."