I’ve been researching (again) about social determinants of health, which are now easily referred to as SDOH (first part of the package). I watched a video about the Wonder Women of Indonesia who are empowering families with skills to use clean energy technology — they packaged it. I started thinking about how we as Americans have it so easy with our clean, drinkable water. Then I thought about how people were not always so good about drinking water. What changed? They packaged it. Now, during the pandemic bottled water is flying off the shelves.
Why is Amazon so successful? They packaged it. Everything about it. The boxes, the delivery system, the shopping, the ordering, even the returns. Everything is packaged so nicely, it makes everything so simple. It might have been more costly in the beginning, but once people caught on to the packaged shopping system they became hooked.
How did Starbucks get people to drink more coffee? They packaged it. “We have these specialty coffee drinks that you will love!” Yes, they love them, but they also love the personalization of it. Extra hot. No Foam. Nonfat milk. It’s a customized package, even better.
It probably all started with McDonald’s and the “Happy Meal.” This packaged deal even gives you incentive for buying by including a toy to quiet your child!
Back to social determinants of health. These are factors or circumstances or small details that affect our optimum wellness. When I moved to the City of Angels, I learned firsthand what it meant to not have access to healthy food options. Parking is limited in the city. Even when I did pay the monthly costs to park in a structure, it was a 12-minute walk to my six-story building. Carrying groceries was a pain. I would double-park and angry people would yell at me. Someone even yelled at me when I attempted to park along the yellow curb for “unloading” because I was taking the parking space she had been waiting for, for hours. When I did find parking on the street, I didn’t want to drive to Trader Joe’s — which turned out to be a 30-minute one-way commute with the city congestion and parking. All of this was mentally stressful, so I had to make a choice about what was more important: my mental health or my physical health (better nutrition).
I attempted to maintain both my emotional and physical health. I tried every “packaged” food delivery system possible, but it turned out to be too much food for one person. Plus, it became very expensive. What do people in the city do who cannot afford monthly parking and cannot afford the packaged home delivery? SDOH and health disparities and one healthy choice weighed over another. Do you feed your kids or yourself? Do you feed yourself or your dog?
I never realized before just how important it was for me to have easy access to healthy food options. While living in the city of Los Angeles for two years, I shopped at Whole Foods twice. The first time, I stopped at the one downtown on my way home from visiting friends in Long Beach. It was a Sunday evening and the organic fruits and vegetables were cleaned off the shelves, nothing left. The second attempt to shop at Whole Foods was three miles the other direction in Fairfax District, but the rioters who infiltrated peaceful protests destroyed that store to the point of it being non-operational. This is when I decided to leave the city.
Now, I’m in, comparably, a suburb of L.A. where Trader Joe’s, Whole Foods, and Sprouts are all within five minutes away from where I live. The move cost close to $5,000, which is why people aren’t able to get out of the city. Plus, cost of living is higher in this area. People who cannot afford to make changes to improve their health, must deal with their circumstances. Health disparities and gaps result.
So, how can we as communities address SDOH to make it easier for people who are unable to change their circumstances? People who have to make decisions day-by-day about which factor affecting their health is most important in that moment. The answer is to figure out a way to package it. Bring the healthy food options to communities by opening Farmer’s Markets. Well, now that we have a pandemic, that is not an option. Have free classes at community centers and senior centers nearby. That is not an option right now either.
As programs have transitioned to remote operations, organizations are discovering that most people who were challenged with certain elements that affect health (SDOH) also do not have the technological capabilities to participate in these programs. And the only way to overcome these barriers is to subsidized or purchase smart phones, notebooks, laptops, or computers, as well as the internet or Wi-Fi connections or data plans.
There are two problems, even when organizations have the limited budget to do this: (1) The digital divide and training people in these new technologies when you cannot do it in person; and (2) People (especially older adults) enjoy the “old school” methods of talking on the phone. They prefer NOT to become technologically savvy. But it’s only because we haven’t figured out a way to “package this deal” or this system yet.
I guess it doesn’t surprise me that we haven’t figured out a package. We have been studying determinants of health for many years; and just recently, it became a focus in strategic planning. Only because they figured out somewhat of a return on investment — more so related to health outcomes rather than monetary gains.
Either way, it is complex. Health and wellness is complex. SDOH is complex. And the solution to complex problems or systems is to package it as simply and easily as possible. Bottle it. Give us a kit. Do the work for us. And in the end, it will be more cost-efficient for everybody.