When you think about healthcare, what comes to mind? Probably hospitals, doctors’ offices, pharmacies, and insurance companies. These are indeed all pieces of the healthcare puzzle, each playing a crucial role in a person’s healthcare journey. Historically, they have been mostly concerned with physical drivers of health: the structural and functional components of the body — bones, muscles, organs, and systems — that can be tested, measured, and treated in clinical settings. But equally important are the behavioral and social drivers that impact your health.
According to the National Academy of Medicine, social drivers of health contribute 80 to 90% of health outcomes for a population; what we normally think of as “medical care” only accounts for the remaining 10 to 20%. That makes sense upon reflection: Medical care is most often where people turn only after something goes wrong.
But there are other factors that have an impact on your whole health: grocery stores; gatherings of friends and family; the sidewalks, parks and other places where you get exercise; and even your home and workplace. These are the places where your health is often determined and should be among the first areas of focus when you think about caring for the health of yourself and your family. If you don’t have access to nutritious food or to behavioral healthcare when you need it, it’s hard to be as healthy as you possibly can.
To improve health, the healthcare system needs to broaden its view and redefine what health is. That means working from within to identify what factors drive health for each person — looking at the physical, behavioral, and social drivers of health — and then applying those learnings to the broader system. It also means forging community partnerships to consider, identify, and address the most significant health drivers and health barriers for different populations. A whole-health approach aims to improve outcomes for people and communities, and it works to advance health equity.
What Makes Up Whole Health?
Physical drivers of health are all the components of our body that make us function from day to day: our heart, bones, muscles, blood, nervous system and everything in between. When you go to the doctor, it’s likely to treat or check these physical systems. But a holistic approach helps people achieve their highest level of health and wellness by focusing on improving health for the whole person, rather than only treating symptoms and conditions.
For example, preventive care reduces risk of diseases, disabilities, and death; but only 8% of people over 35 receive all the high-priority, appropriate clinical preventive services recommended for them. A whole-health approach looks at the reasons why someone isn’t getting that preventive care — Is it lack of transportation? Fear of illness? — and helps address them in time to improve health outcomes.
Behavioral drivers of health are the genetic, familial, cultural, and societal factors that impact a person’s overall health and wellness. These include psychological factors such as mental health and substance use disorders, as well as reactions to external factors. Behavioral health is impacted by physical and social drivers of health and vice versa.
Behavioral health is just as important as physical health, and they have a profound effect on each other. Physical and behavioral health conditions often go hand in hand: depression, for example, increases the risk for physical conditions like diabetes, heart disease, and stroke. Likewise, people with chronic physical conditions experience depression and anxiety at double the rate of the general population. For all these reasons, it’s crucial to reduce the stigma around behavioral health so that each person can get the support they need to be as healthy as possible.
Social drivers of health include how a person lives and how they react to and interact with their community and physical environment. Social drivers — sometimes called social determinants of health —include social activities, housing, food, communication ability, transportation access, income, and access to healthcare. These are also known as health-related social needs; unfortunately, many of these needs go unmet. For example, 1 in 4 Americans worries about losing their housing, and many types of housing instability are associated with poorer health outcomes. Another 1 in 5 Americans says that lack of transportation has kept them from medical appointments, work, or getting the things they need.
Holistic Healthcare and Communities
Research has shown a strong link between the strength and quality of social interactions and a person’s overall health. Relationships are linked to mortality and adverse health outcomes; those who have the lowest social involvement are at highest risk of conditions that range from cardiovascular disease to slower healing from injury, in addition to the more expected impacts on behavioral health. Unhealthy relationships can cause significant stress and lead to depression and degraded physical health. Community support and partnerships are an important piece of the whole health puzzle.
Partnering at the community level allows us to consider, identify, and address the most significant health drivers. When we do both, we can remove barriers and offer support for each person’s physical, behavioral, and social drivers that are most likely to maintain and restore their health.