SOne of the best business opportunities in healthcare will involve the development of technologies that analyze and address the factors that contribute to health inequalities. These opportunities have the potential to help people—particularly those who are neglected or unserved by today’s healthcare system—maintain their health through proactive, holistic care and reduce the need for doctor and hospital visits.
Social drivers of health are those aspects of life that affect an individual’s health outside of health care itself. They account for up to 80% of a person’s health.
Social drivers include where you live, the condition of your home, the foods you have access to, your transportation options, how much education you have received, your financial security, and more. For example, if your living conditions mean you don’t have access to healthy food nearby, or affordable transportation to a better grocery store, don’t have access to a safe place to exercise, and can’t get much sleep due to your living conditions, it’s much more likely that you eat poorly, get stressed, get sick, and end up in an emergency room.
Tackling social health drivers is often left to government programs and policies that are subject to political winds and lack innovation or speed. So, unhealthy lifestyles – as a result of an unhealthy environment – remain a huge problem. But enormous problems are fertile ground for innovative founders who change the world to start new companies.
My wife Andréa and I have seen the impact of social drivers first hand. After I retired as CEO of Merck, she and I started a clinic to bring quality healthcare to my old neighborhood in a poorer Philadelphia neighborhood. We quickly discovered that many of the residents’ health problems stemmed from their lack of access to fresh, healthy food. In fact, this neighborhood is what you might call a food desert. With little access to healthy food, people in the community have to rely on processed, fatty foods and are more likely to develop diseases like diabetes and clogged arteries.
What the research shows
Social drivers of health are far more detrimental to minority and low-income populations, as they are more likely to live in neighborhoods without good grocery stores; tend to live in inferior conditions; and tend to forgo preventive measures for reasons of financial and health literacy.
Nearly 10% of black Americans do not have health insurance, compared to 5% of white Americans, and the lack of insurance causes people to delay medical care until a problem becomes severe. Covid-19 also made it clear that health care in rural America remains scarce. More than 180 rural hospitals have closed in the past 10 years, leaving many small-town residents traveling for hours to see a doctor.
Improving the social drivers of health has typically been a matter for public health agencies. There have been some notable achievements: effective sanitation systems, safer drinking water, reduced air pollution, anti-smoking campaigns and more have added years to life for everyone, including marginalized people.
But the best way to understand and address social drivers and health inequalities today is to build companies that venture profitably to solve such problems. No company can solve everything; it requires an ecosystem of companies and technologies working together, and radical collaboration with existing healthcare systems.
A number of companies are leading the way, including Cityblock Health, a General Catalyst portfolio company I work for. Founded in 2017, Cityblock uses software and partnerships with insurers and hospitals to bring healthcare to people on low incomes. The company is now worth more than $6 billion.
Another is dad. The company recognized that when seniors living alone have some company and a little support in their lives, they are less likely to get sick and require expensive medical care. So Dad built a platform to match young adults with seniors and uses the platform to offer services like telemedicine and chronic care that help seniors live at home and stay away from hospitals.
Here are some of the avenues I think founders of companies looking to tackle health inequalities should consider:
Collecting Data on Social Drivers
Data is key to healthcare — a new category of healthcare that uses technology to help everyone stay healthy and manage their condition, so they rarely need “sickness care” in a hospital or doctor’s office.
While electronic medical records contain health data like prescriptions, heart rate, and lab work, they contain almost no information about social drivers of health — and no data linking them to other medical conditions. In other words, medical professionals have no empirical evidence of how their patients’ social needs affect their health.
According to a study published in Health Affairs, healthcare professionals “often fly blind, lacking data on both the social needs of their patients and the capabilities of potential community partners.”
A company that can collect data on the social determinants of health, correlate it to health outcomes, and analyze the data to find better ways for people to stay healthy and manage chronic conditions would be tremendously valuable. I could imagine a pharmaceutical company wanting to become a customer to understand why drugs are more or less successful in certain population groups. Health insurers would also find such information valuable.
While creating such a pool of data would no doubt present a challenge, the future of healthcare actually depends on someone getting it right.
Link health care with social services
There is a shocking lack of any kind of consolidated database of organizations that provide social services that can improve health. For example, a doctor treating a patient with diabetes who lives in a food desert cannot open an app and find a subsidized fresh food delivery service that could help her patient eat better.
Achieving health security means connecting all aspects of health. Doctors should be able to prescribe a social service that improves health just as easily as they prescribe a pill. The US needs companies that make this possible.
improving health literacy
In my old neighborhood, some people with diabetes only come to the clinic when their condition is so bad that they have to have a foot amputated because of diabetes-related circulatory problems. A tool that can educate and encourage disadvantaged people to get screened for breast and colon cancer, diabetes or heart health would be extremely beneficial. Many economically disadvantaged people simply do not know enough about their health and healthcare options to get the help they need before the disease becomes serious.
I see the need for a company that develops a health literacy application that targets marginalized populations. The “concerned healthy” don’t need this – they tend to research (perhaps over-research!) their health conditions and have easy access to medical care. But people who aren’t so lucky need guidance that feels like it applies to them.
More virtual care
It is simply not possible to train enough doctors and build enough hospitals to provide every American with easy access to care. Quality care is unattainable, especially for those living in inner-city and rural towns. The solution in the age of mobile devices and cloud computing is virtual care.
Of course, telemedicine already exists. And in the early days of Covid-19, it seemed like it was going mainstream. But it didn’t. Maybe it’s like the early years of video conferencing, when apps like WebEx were used only occasionally, until the pandemic and Zoom collided and video calls became as common as voice calls. Zoom’s brilliance was in making it robust and easy to use. We need Zoom-like advances in telemedicine and business models that make them work for rural and inner-city populations.
At General Catalyst, our mission is to work with founders to bring startups to life that address the social causes of health and health inequalities. Health insurance companies will shape the future of our collective health and well-being by bringing to fruition the technologies and solutions that enable proactive, holistic care that is truly accessible to all and serves our society at large.
Ken Frazier is Chairman of Health Assurance Initiatives at General Catalyst, a venture capital firm, and is the current Executive Chairman and former CEO of Merck. He is also a co-founder and co-chair of OneTen, a coalition of organizations dedicated to training, hiring and promoting one million black Americans into family-support jobs.