Introduction

The World Health Organization (1946), defines health as an integrated approach to physical,
mental and social well-being and not restricted to the absence of illness. Over the past several
decades there has been a move away from the traditional pathological view of health and well-
being, to the more practical and holistic salutogenic approach (Lindstrom and Eriksson, 2006).
This categorizes the different aspects of health and categorizes them under the term dimensions
of health, allowing for the implementation of a holistic plan of care and a person-centred
approach (NMC, 2014). According to Hjelm’s (2010) model, there are six dimensions to
consider, each being interconnected and having a positive or negative impact on the others. The
physical dimension of health relates to the biological processes of the body’s various systems.
Mental health pertains to an individual’s mental state. This is closely linked to emotional health
as this has a significant impact on their mental health (Stevenson and Sloan, 2012). Spirituality
closely relates to all other dimensions of health and creates a sense of worth and purpose for the
individual (Bensley, 1991). This paper will discuss the extent to which Social Dimensions of
health comply with social dimensions. This will be done by giving practical examples

The five social determinants of health action

1. Build the collective will

Ownership and responsibility are evident when real costs are understood. A single player cannot
solve the root causes of the disease. But not many players seem to be trying at all. More than a
third of respondents surveyed in PwC's 2019 HRI Global Consumer Survey indicated they were
not engaged in discussions with any stakeholders about social, economic, behavioral and
environmental factors affecting their health. 43% of the users surveyed said they had discussed
these factors with physicians, but pharmacists, physicians, nurses and other health experts are
discussing the subject at a very low level. The disparity highlights the huge opportunity to
engage other health system workers in promoting conversations about health social determinants.
This will require a coalition of partners who may need to enhance their role, but leaders must
find ways to show prospective partners how their goals are meaningfully consistent. To build the
right alliance, it will also be necessary to look beyond the sector and traditional partners who can
contribute to it to consider community groups, government institutions, universities, retailers,
technology companies and new entrants.
Governments can act as conveyors by focusing, adopting policies that encourage action, provide
investment, or create incentives for players to lead. Describing the overall costs for the health
system and society can help motivate athletes. There was evidence that the estimated direct cost
of medical care, due to people being overweight and obese, increased by 61% from 2000 to
2008, Mexico launched a national anti-obesity nutrition and health pact campaign in 2010. The
program brought together five business groups and 15 federal agencies, including the Ministries
of Health and Education, to work together with a focus on the school age population. (WHO
2021)

In other cases, companies have stepped up as convenors. Digital health startups in the United
States help health-fi healthcare organizations find partners and integrate to deal with health
social determinants. It recently announced a collaboration with Landmark Health to help connect
its complex, chronic patients with medical, behavioral, social and healing care. Healthify (2021),
Employers are recognizing that a different approach is needed, and some are taking a more
activist role. (PwC 2019)

"While dealing with social factors is not the primary responsibility of the health insurers, it has a
general social responsibility," Dr. Isabella Erb Herman, authorized representative of the
management board of AOK Hesson, a major health insurance provider in Germany, said in an
interview with THE HRI. Health care organizations in Germany have begun work on the
National Action Plan Health Literacy for Germany to improve health literacy, a key social health
determination. But the effort requires a common goal "for everyone to understand that this one
party can't do anything on its own - it requires a cross-sectoral effort to do it," Erb Harman said,
adding that facts and data that cannot be disagreed on help anchor partners in the debate.

While a health-focused social determination can yield tremendous savings for the overall system,
its payment cannot be seen for years and can extend to two or four election cycles. It is easy to
handle and reduce efforts for a culture of defeatism. But coalitions can develop evidence-based
public campaigns to win community by in, which help reduce some of the political risk involved
in making up-front investments. The media's attention showing vast disparities in the health
status of different population stake can also increase political pressure to act. Furthermore,
alliances can turn to alternative funding mechanisms, such as social impact bonds, enabling the
risk to be shared by public and private stakeholders. Aligning public and private budgets from
the health and social services sector can maximize the costs of each institution and create
benefits for all.

Efforts to address social determinants of health often have not scaled beyond the pilot stage
because of difficulties in quantifying the immediate and long-term value to risk bearing
stakeholders. However, by developing common frameworks and harnessing the power of data
analytics, organizations can build the infrastructure that will produce evidence for the business
case.

2. Develop standard but adaptable frameworks

Coalition partners should adopt a common framework to clear obstacles and fast-track efforts to
work together.

Once they work hard to form a coalition, partners must overcome the daily challenges of
merging different workplaces with different missions, incentives and perspectives. Consumers
expect care to be better integrated to create a seamless experience; nearly a third of respondents
in the 2019 HRI Global Consumer Survey indicated there was an opportunity to better connect
healthcare and social services. The next important step, therefore, is to create a guiding
framework that will allow partners to work together effectively for their common cause. The
framework must establish a clear role and set a common word, goals, value appreciation and
decision-making protocols so that the team can move forward on its roadmap for change.

Coalition leaders should be confident that all partners are invested and agree on a common goal.
They must set clear expectations and establish a common language, as the terms used for social
determinants measuring health intervention may vary from organization to and outside. Leaders
should be clear how members will achieve change and goals should show how each player
benefits from alignment of partners' work. Trust will play an important role. Agencies and
organizations will not only have common goals, but can share important data or contribute large
sums of money. In some cases, efforts may have to overcome misunderstandings about
controversial dates or other parties' work.

Even if all partners belong to a sector like government, they can still follow different protocols
and procedures that can prevent efforts to work together. In response to the methamphetamine
crisis in Canada, for example, in 2018, overlapping agencies working in mental health and
addiction in Manitoba partially reorganized the system to focus on issues such as outlawing
addiction and discrediting mental health. The Shared Health Manitoba effort convened officials
from justice, social services, education and health departments to better coordinate services for
proactive prevention and screening measures and increased access to specialist care
opportunities. (Shared Health Manitoba 2019)

Recognizing the unique capabilities of each organization can create a strong partnership. Formed
in 2012, the Western Sydney Diabetes Alliance diversifies more than 110 partners like a chain of
local health providers and food stores. "We are not medical professionals, we are not necessarily
health professionals, but we can engage with all levels of government," said Stuart Eastwood,
CEO of Diabetes NSW, one of the coalition leaders.

Recognizing the unique capabilities of each organization can create a strong partnership. Formed
in 2012, the Western Sydney Diabetes Alliance diversifies more than 110 partners like a chain of
local health providers and food stores. "We are not medical professionals, we are not necessarily
health professionals, but we can engage with all levels of government," said Stuart Eastwood,
CEO of Diabetes NSW, one of the coalition leaders. Regularly scheduled meetings that bring
partners together to monitor progress are also important. Successful steps that go beyond the
discussion phase have been powered by key executives who pushed the group and set up
calendars of meetings and working groups that held partners accountable.

3. Generate data insights to inform decision making

Choosing to invest the program may seem the most likely to be a mysterious effort to improve
health. But leaders are finding that prediction analyses could illuminate areas to target what
would mean wasting less time and money chasing ineffective interventions. New Zealand has
shifted to a ‘social investment’ approach, using data analysis to identify groups to target with
earlier interventions that can improve overall wellbeing and reduce the need for social welfare
program over their lifetime.

Australia is on a similar path. The Australian Preferred Investment Approach for Welfare uses
actuaries analysis based on official data to estimate the overall future welfare costs and where the
government can invest first in a person's life to improve quality of life and employment prospects
while government spending for future health care Can reduce.
Multinational corporations, too, are using social determinants of health data strategies to improve
health. Recognizing the impact of poor health on worker productivity, global chemical company
BASF in 2008 estimated the sick leave rate for employees in 2020 based on epidemiological
factors (e.g., age, gender, risk factors for chronic diseases, smoking rates). Using prediction
analyses to inform its strategy, the company targeted corporate health management programs to
prevent groups of employees from getting sick or creating chronic conditions through safety
measures such as optional health checks. Since this analysis, "We found out that we didn't get as
sick a holiday as we calculated in the year 2008,” said Dr. Stefan Webendoerfer, Vice President
for Diagnostics and Health Promotion for BASF SE, in an interview with HRI. “We saw that if
we catch them early, we can avoid some of the long-term leaves, too.”

If alliances do not have the data required for such analysis, they can fill gaps with
unconventional sources such as consumer marketing data, wearable monitors data, social
interaction websites and survey data that look at exercise, sleep habits or adherence to
prescriptions. Partners will need to coordinate platforms to make information available and
usable for all partners while addressing cybersecurity and patient privacy concerns.

Organizations should simultaneously improve data collection involving health social

determinants, expanding the categories of data collected using opportunities such as adopting
new electronic medical record systems or upgrading them to data systems. For example,
recognizing that it wanted a more effective gauge of patients’ social isolation, CareMore Health,
a US-based integrated care organization, built a ‘loneliness scale’ that is part of the electronic
medical record shared by doctors, social workers and dietitians.

But how do you really change your behavior to benefit people from their health? Prediction
analyses can also be used to consider both individual behavior and population behavior. Many
consumers feel some individual responsibility to make the change, but 47% of PwC respondents
The 2019 HRI Global Consumer Survey indicated that health care providers are not sharing
predictions about whether these patients may need health care services in the future, considering
their medical history. Even When the vigas are encouraged, they often lack information or tools
to prevent chronic conditions. Organizations should use analytics to understand who needs
information, and what interventions can best help them become healthy.
2019 HRI global consumer survey indicated healthcare providers are not sharing predictions
about what healthcare services these patients may need in the future considering their medical
history. Even if people find the motivation, they often lack the information or tools to prevent
chronic conditions. Organizations must use analytics to decipher who needs the information, and
what interventions might best help them become healthier.

Data from the patient's circulation, respiratory, digestive, endocrin and kidney systems at the
individual level can be used to create a digital mirror of the body's physical system and
functions. Teams can mathematically represent how a person's future health will change over
time. Behavioral science research can be used to create models that predict an individual's
possible response to various environmental, lifestyle or medical interventions. The prediction
algorithm can predict habits that will affect health, including diet, physical activity, sleep,
medication adherence and medical care use.

This approach can be passed on to the entire population for more powerful insights. With
machine learning and simulation modeling, organizations can see how their original community
and environment are interrupted by a pool of individuals. For example, if an alliance that focuses
on improving health outcomes in a neighborhood decides to create walking routes, how will that
population react to this intervention? If the Coalition opens a grocery store in an area where
nutritious and fresh food choices have been limited, will it change people's eating habits in ways
that can slow diabetes rates? These strategies allow organizations to look at forecasts for how
populations will respond in the first year, ten years down the line and over their lifetime, and to
further quantify the impact of these investments, even prior to making financial commitments.
Solutions can be micro to the individual, such as a ride-sharing connection program, or macro to
the population, such as a broad promotional campaign to push for more public transit stops.
These insights will keep partners invested by quantifying the value in return on investment,
treatment costs avoided and healthy years added.

4. Engage and reflect the community

Social determinants of the health program should be based on the fact of how people live and
work. Building collective will, designing an effective framework and deploying data are all
necessary measures but they are not enough. The success of any social determinant of health
strategy ultimately depends on the response of the targeted community. The interventionists
should have the credibility and knowledge to work in this area so that they can build confidence
in the population. Frontline health workers from rural India to suburban Canada know the real
obstacles to better health among those they serve. In Ontario, Canada, community care
coordinator Ruen "There are many situations where I think, 'Wow, if I were involved from a
preventive point of view first and if people were aware of and accessing community resources
and healthcare services, their current situation and outcomes would have been very different,"
Kalra said in an interview with the HRI.

Partners should consider the interaction of these frontline workers and how they will be viewed
in the community, whether with suspicion or respect. Systems and policy makers need to take
care not only of cultural differences but also of geographical disparities in the resources seen
between states and regions; life expectancy can vary dramatically for people living within the
same country. In one US community in Texas’s Rio Grande Valley known as “Diabetesville,” a
staggering two-thirds of the population were living with diabetes, diagnosed or undiagnosed. The
towns suffered from a lack of primary care providers.46 A coalition including the University of
Texas formed to tackle the problem and placed screening and prevention program in locations
where residents were, allowing them to check their blood glucose and blood pressure at
retailers.47 Community health workers visited people in their homes. The program increased the
health literacy of people who did not know they were at risk for chronic diseases, lowered the
glycated haemoglobin (HbA1c) of patients with diabetes and reduced hospital/ER readmissions
for the high utilizers.

5. Measure and redeploy

Partners should use evidence to improve and enhance social determinants of health efforts and to
keep partners accountable. What would help someone living in the food desert eat nutritious
foods, or what would encourage a teenager to put down a gaming controller and go for a walk, or
crack the code for something that encourages a middle-aged worker to turn off computers and
sleep is not easy. Successful social determinants of health intervention campaigns are continuous
improvement exercises, bringing together experience, data and insights and feeding back into the
system. Opinion enables the development of better strategies and shows that partners need to
better socialize health capabilities or strengthen processes. HRI completed a meta-analysis of
more than 20 global case studies of a variety of organization types to determine the metrics that
were most prevalent in reporting progress for social determinants of health interventions. This
analysis revealed two groupings of metrics used based on audience: financial and biological
measurements.

Projects require a combination of financial and biological measurements depending on the type,
cost and scale of intervention. The PwC case study for a UNITED States-based integrated care
organization looked at financial and biological factors, looking at both the ROI and the social
impact of two different interventions: grocery stores in the food desert and increased income and
insurance. For both interventions, the organization measured the healthy life years gained and
medical cost savings and determined that employment and associated revitalization would have a
larger social impact than a grocery store.

In many cases, the community benefit of an organization's participation in the programming of

social determinants can be concealed, and it can be unveiled by the ROI Dashboard which also
examines how the benefit of the community can be multiplied. As organizations use metrics to
reveal gaps in business capabilities, they also need to build in accountability, such as
incorporating expectations for internal leadership, making sure to address needs of coalition
members and building social determinants considerations into contracts.

Conclusion

Social health dimensions include continuous development and achieving balance in all health
dimensions. Many people think only of "health" in terms of physical health. This word demands
ideas of nutrition, exercise, weight management, blood pressure etc. However, social well-being
is much higher than physical health. Social health is a complete integration of physical, mental
and spiritual well-being. It is a complex interaction that leads to quality of life. Wellness is
generally seen as seven dimensions. Each dimension contributes to its sense of well-being or
quality of life, and each affect and overlaps others. Sometimes one may be more prominent than
others, but neglect of a single dimension for any period has a negative impact on overall health.
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