Health Affairs: Drivers of Health

Words matter. John R. Lumpkin, MD, MPH, Vice President Drivers of Health Strategy, recently shared why Blue Cross and Blue Shield of North Carolina (Blue Cross NC) uses the term “drivers of health” instead of “social determinants of health” and the connotations associated with each term in this recent Health Affairs article.

People – voters, patients, members, and consumers – find the language of both “social determinants of health” and “social needs” confusing, alienating, and even demeaning. As has been observed in another recent Health Affairs article, words matter. In the present context – with the pandemic having yielded devastating unemployment, thousands of cars waiting in line at food pantries, a flood of imminent evictions, political discord, and racial inequities laid bare – they are more important than ever.

By listening carefully to Americans and the physicians who care for them, we gain crucial insights. Voters across the political spectrum believe that our focus should be on health, not just health care. Likewise, a STAT article on health care reform points out that physicians are concerned that our country chronically under-invests in addressing those community and societal factors outside the clinic that drive poor health outcomes. Yet, despite this concordance in values, we lack concordance in action.

One way to spur action is to adopt language that reflects these shared values. A North Carolina Institute of Medicine report (PDF) points out that a growing number of institutions (including our own) have adopted the term “drivers of health,” viewing it as more respectful of community members and less suspect to the separation of the self from the “other” that fuels racial inequities in health care. This language also allows us to distinguish between “individual drivers of health” and “community drivers of health,” mitigating the confusion described above and recognizing that these each require different approaches, as explained in a 2019 Health Affairs article on social determinants of health.

To learn more about our efforts to improve drivers of health, read the recent article from Health Affairs.