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Moody’s Report First to Measure Social Effects on Health in Every County

By Gregory A. Freeman  
   January 02, 2018

Blue Cross Blue Shield health data were combined with information on social determinants of health. The result illustrates how the factors affect commercially insured Americans county-by-county.

A recent report is the first of its kind to identify the health conditions with the most impact on the commercially insured, along with the socioeconomic factors that play into them, for every county in the United States.

A Moody's Analytics report, prepared for the Blue Cross Blue Shield Association (BCBSA), breaks down the links between social determinants of health and differences in health across communities.

Moody's Analytics utilized the Blue Cross Blue Shield Health Index, which identifies the health conditions with the greatest impact on the commercially insured in each county, pairing it with data on socioeconomics and other social determinants of health. The combination reveals how the level of health impact of these conditions is influenced by factors such as income, level of education, community health behaviors ,and local health system characteristics, the companies report.

The report, "Understanding Health Conditions Across the U.S.," shows that social determinants of health drive larger differences in the impacts for common chronic conditions such as hypertension, diabetes and coronary artery disease. In addition, the analysis shows these determinants drive smaller differences in the impact of other conditions such as cancer, substance use disorder and mental health, which are influenced more by individual factors such as family health history and personal lifestyle choices.

Differences in local healthcare system characteristics have a more modest association with the health impact of disease on a community's commercially insured population, the report says.

Maureen Sullivan, chief strategy and innovation officer for BCBSA, says the analysis shows the need for continued improvements in the economic opportunities and social influences that drive healthy behaviors within a community.

The BCBS Health Index uses de-identified data from more than 40 million commercially insured members of BCBS companies. The index shows that five conditions nationally are responsible for 30% of the adverse health of this population: depression, anxiety and other mood disorders; hypertension; diabetes; high cholesterol; and substance use disorders.

The index quantifies how more than 200 common diseases and condition categories affect overall health and wellness by assigning each county a health impact measure between 0 and 1, designating the proportion of optimal health reached by the county's population.

“Altogether, unique health conditions are somewhat driven by socioeconomic, demographic and behavioral factors,” the report says. “However each condition also has distinctive features -- including treatment effects, low prevalence and genetics -- that potentially qualify them for a different analysis method than that of other conditions.”

The findings show that “demographic, behavioral and structural factors impact health conditions in different ways and that greater insight into these differences is critical to understanding county level population health using the BCBS Health Index,” the report says. 

Gregory A. Freeman is a contributing writer for HealthLeaders.

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