Addressing social determinants of health to improve long-term wellness in RI's older adults

Posted 2/25/20

By COREY McCARTY "e;Gloria"e; is a 78-year-old Rhode Islander. She is a retired teacher on a fixed income who lives alone. She's also living with diabetes. Her doctor is concerned about Gloria's frequently missed appointments and why her blood glucose levels

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Addressing social determinants of health to improve long-term wellness in RI's older adults


“Gloria” is a 78-year-old Rhode Islander. She is a retired teacher on a fixed income who lives alone.

She’s also living with diabetes. Her doctor is concerned about Gloria’s frequently missed appointments and why her blood glucose levels seem to jump all over the place when she’s been managing her diabetes for more than 5 years.

What her doctor doesn’t know is that Gloria was forced to move recently, and unfortunately, there are few apartments that Gloria can afford. Her new apartment, which is still more expensive than what she can really afford, is also far from public transportation. Because of her increased living expenses, she is struggling to pay for her diabetes medication and testing supplies.

It’s clear that Gloria is having a hard time managing her diabetes. She now has an incredibly difficult time getting to her doctor’s office, getting to a supermarket to buy healthy foods and affording her medications. How much of a priority is Gloria’s health when she’s worried about paying for her apartment? These geographic, economic and social factors are called social determinants of health (SDoH) – the conditions in which people are born, grow, live, work and age – and they often have the biggest impact on your health.

A 2018 AARP survey found that 51 percent of low-income older adults lack access to nutritious foods and more than 30 percent worry about having adequate transportation. With these deficits at the most basic levels, older adults risk not being able to follow their physicians’ care instructions – if they can even get to their medical appointments in the first place – despite their desire to stay healthy.

Research has shown that only 20 percent of a person’s health can be attributed to medical care. Meanwhile, life factors like access to nutritious food, stable employment and income, safe and affordable housing, and reliable and accessible transportation account for 50 percent. For older adults, these SDoH can impact their ability to stay active in their community, stay engaged socially, manage health conditions and live independently.

Within the healthcare system, the push to address SDoH is mounting as evidence grows that more upstream solutions may be the key to reducing disparities and increasing the potential for better long-term health. These innovative offerings may include things like healthy in-home food delivery, transportation to and from medical appointments, or classes and events to enhance social interaction. Better addressing the underlying SDoH that may impact health outcomes is a step in the right direction.

In 2019, as a way to address social determinants of health, Blue Cross & Blue Shield of Rhode Island (BCBSRI) partnered with the Brown University School of Public Health to create the RI Life Index, a new data resource focused on the life factors that influence health and well being. The survey results, representing Rhode Islanders’ perceptions about their own health and well being, found that the availability of, and access to, safe and affordable housing is a significant concern and challenge across the state. In line with these findings, BCBSRI will dedicate its 2020 BlueAngel Community Health Grants program to housing solutions, with the expectation that by investing in access to safe and affordable housing, health outcomes for many Rhode Islanders will improve over time.

BCBSRI’s commitment to investing in communities, leveraging available resources and working together to find innovative ways for Rhode Island’s older adults to stay active and live independently continues to grow. Some recently launched initiatives aimed at addressing SDoH include:

Personalized care in a community-center setting: BCBSRI partnered with Oak Street Health, a network of primary care centers that delivers personal, equitable and accountable care to adults on Medicare. Oak Street Health’s three centers in Providence and Warwick offer dedicated physicians and care teams, complimentary door-to-door transportation and a 24-7 telephonic support line.

Face-to-face service and classes: To stay active and social, Rhode Islanders can stop by any of our four Your Blue Store? locations to take advantage of free classes like Zumba, yoga and nutrition education. In East Providence, Lincoln, Warwick or Cranston, members can connect and improve their health in a cost-effective way. While they’re at it, they can get answers to healthcare questions and have a health specialist review their medications.

Innovative solutions for health and wellbeing: BCBSRI’s Medicare Advantage members have access to transportation for visits to a primary care provider (PCP) or a specialist; home-delivered meals following a hospital stay (up to four times per year); and access to telehealth through Doctor’s Online, which connects members, by smartphone, tablet or computer, to top-rated, board-certified doctors.

Through innovation and partnerships, we can identify gaps and common barriers that older adults face on their journey to maintaining their health and their overall well-being. With a strong focus on making healthcare more accessible, and a renewed focus on the social factors that are holding Rhode Islanders back from their best health, BCBSRI is committed to supporting older adults across the state. To read the RI Life Index findings, please visit rilifeindex.org.

Corey McCarty is vice president, consumer segment, for Blue Cross & Blue Shield of Rhode Island.


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