Martin Duggan, Director Strategy and Market Dev, IBM Cúram, IBM Industry Solutions

I lead strategy and market development for Social Programs in IBM Watson Health - the division of IBM dedicated to Health and Human Services. As part of this I run the IBM Cúram Research Institute - IBM's social policy research arm.

Addressing the Social Determinants of Health

May 10, 2013 AT 3:37 PM

Healthcare has reached a critical tipping point – society is aging rapidly, people are living longer and cases of chronic illness are increasing drastically. All these factors are putting enormous pressure on systems of care around the world. And, the cost of healthcare is becoming unsustainable. It is estimated that 20 percent of the population generates 80 percent of healthcare costs [1].  Therefore the most logical way forward is to start addressing the social determinants of health.

Education, housing, family conditions, community, employment and social protection all have a direct impact on health: For example:

  • Social and environmental factors may contribute as much as 40 percent of the variance in health [2].
  • More than 75 percent of direct healthcare costs are due to chronic conditions which are preventable [3].
  • Providing permanent supportive housing to the homeless community reduces healthcare costs by 59 percent [4].
  • In Europe, overall, death rates among men increased by 44 percent during the first four years following job loss compared with a control group [5].

These examples make clear the importance of factoring the social determinants of health into planning and implementation with the end goal of sustainable health outcomes. To do this, horizontal policy-making and implementation is necessary – the Smarter Care approach.

Through the IBM Cúram Research Institute, we have identified five activities that are fundamental to Smarter Care: identify, assess, respond, manage and measure. Implemented across the systems of care, they enable the delivery of better outcomes for individuals and society, and ultimately to lower costs.

Incorporating social determinants into care can lead to lower recidivism rates and commensurately lower primary program costs. A multidimensional, holistic approach to healthcare can also improve services, reduce costs and create better outcomes for individuals and society. Although innovation and change will not be easy, making the decision to innovate and change is.


[1] U.S. Department of Health and Human Services. The High Concentration of U.S. Health Care Expenditures, 2012. Available at:  (Accessed 9 February 2013)

[2] Institute for Alternative Futures (2012) Community Health Centers Leveraging the Social Determinants of Health. Available at:  (Accessed 9 February 2013)

[3] Centres for Disease Control and Prevention (2009) Chronic Diseases. Available at: (Accessed 2 April 2013)

[4] Greendoors (2009) The Cost of Homelessness Facts. Available at: (Accessed 2 April 2013)

[5] The European Foundation for the Improvement of Living and Working Conditions. (2011). ‘Work and health: A difficult relationship?’, Foundation Focus [Internet], (9). Available from:

Nice post, Martin. Every

Nice post, Martin. Every organizational transformation begins and ends with the promise and impact of breaking down silos. Understanding the social determinants of health are a critical start on this journey.
Aging, homelessness, and physical disability are just a few examples of conditions that add massive costs to healthcare and social programs worldwide. The problem is that none of these can be fixed by the healthcare system or social programs alone.
For decades, small programs around the world have demonstrated the positive impact of coordination between health and social programs. Ultimately, success is about scalability.
It will be a long road, but considering the social determinants of health is a good place to start.
Best, Paul

The ratio is really shocking,

The ratio is really shocking, and I don't understand why this kind of situation occur.



thanks a lot!!

thanks a lot!!

Astonishing statistic around

Astonishing statistic around supportive housing. Would be excellent if healthcare insurers/financially at-risk providers invested more in housing infrastructuer. Another possible way to improve the situation would be to simplifiy the referral process to transitional housing and/or shelters. 



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