What Determines Good Health? (Hint: It’s Complicated)

Doctor talking to senior male patient in a home visit

The last time I saw my adult children in person, it was January 2020. After more than a year, we have gotten used to virtual get-togethers. I was hesitant at first, thinking they felt impersonal. In my family, we get excited to be part of the conversation and tended to talk over each other on our first few virtual meetups. But over time, I’ve noticed that we’re more respectful of each other’s time to speak and we listen more carefully, often discussing topics we wouldn’t otherwise bring up.

In one of our recent discussions, I asked them how they would define good health. One said that being healthy means “not being sick,” adding that someone may not know what good health means until they become sick. Another said, healthy is when you are “mentally and physically vibrant.”

I then asked them what they thought determined good health. They listed things like exercising, eating well, not smoking, family medical history, being outdoors, and having a pet. My son added, “I think your ZIP code has a lot to do with it also.” He was right, and I was impressed with his response.

Healthy Behaviors Are Only One Piece of the Puzzle

In the past, doctors typically spoke about health as a mixture of genetics and lifestyle choices. Health behaviors like good diet, exercise, safe sex, not smoking, and moderate alcohol use are all important in reducing risk for chronic disease.

But why do some people have a harder time following these recommendations? It’s not always a matter of willpower. There may be some factors that aren’t up to individuals, such as being able to get fresh food, having access to safe places to exercise, having the help they need to reduce stress, or being able to isolate during this pandemic.

For decades, public health officials have talked about how the conditions in which people are born, live, learn, work, play, and age affect how easy or hard it is to stay healthy. They call these Social Determinants of Health, and they may include policies, social norms, environmental, economic, technological, and other conditions. These factors can determine whether people have:

Enough money
Clean water and air
Healthy food available
A safe place to live and work
Social support and connection
Education
Access to high-quality health care
Freedom from discrimination

Because of historical patterns of discrimination and privilege, where people live can determine a lot of these — that’s what my son was getting at when he said your ZIP code has a lot to do with your health.

When the factors listed aren’t available, it is more likely that people’s health will suffer. We’ve always recognized that people who “lived a hard life” were often sicker and died younger. Only in recent years have doctors, hospitals, and health insurance companies paid more attention to how social determinants impact health outcomes and how they could help address social needs.

So, What Can We Do About This Problem?

One way to improve this issue is to address people’s social needs. That’s what our new collaboration with Signify Health is all about. When our members have needs around safe housing, healthy food, and legal services, we can connect them to the right people for help.

Independence and Signify Health are pioneering a model that integrates in-home health visits, case management, and a community-based network of services to address social needs, called CommunityLink. Right now, the CommunityLink network consists of the following organizations:

The network will grow to include more organizations over time.

The CommunityLink network brings together Independence registered nurse Health Coaches, Signify Health social care coordinators, and local community-based organizations. These groups help coordinate non-medical services for Independence Medicare Advantage members — and even other members of our community. Clinicians and other health care providers will also be able to use CommunityLink to refer patients in the future.

We understand that good health doesn’t just happen in the doctor’s office — it starts in the community. We hope by helping to remove barriers to accessing healthy food, housing, transportation, and financial support for our members, we can make it easier for them to focus on their health goals.