Harnessing social determinants, data science, and decision-making to address population health challenges in the Eastern Mediterranean – and globally

Author: Sherine Shawky*

One of the most challenging issues facing the Middle East today is how to ensure the health, safety and wellbeing of citizens, including millions of people born in poverty or impacted by political instability and conflict, as well as displaced individuals and refugees, who have emigrated to the region to seek jobs or to escape from poor conditions at home. The vulnerable situations and heightened risk exposures faced by individuals in these situations often intensify individual and population health challenges. Social injustice brings instability, deprivation, and separation from formal social support systems, including essential health care services. Life in slum areas or under a tent in a crowded refugee settlement often means limited access to clean water, sanitation and hygiene, food insecurity and malnutrition — all major contributors to poor health outcomes. A sudden influx of refugees or asylum-seekers creates new burdens for host communities that may already be short of resources.

“We must cultivate data-informed decision-making that values and honors lived experiences and perspectives from the same people health policy is intended to help. We must foster community participation in the data collection process, with full transparency, to build trust. The health, safety and wellbeing of millions of citizens hang in the balance.”

There is perhaps no better illustration of the intersectionality of health and the conditions in which people are born, grow, learn, work, play and age than this. Our understanding of the role that social and environmental determinants play in shaping the health of individuals and populations — and the complex ways in which determinants connect, intersect, and mutually reinforce each other — has progressed substantially in recent decades. At the same time, we have seen tremendous advances in digital technologies that allow us to generate, collect, analyze, disseminate, and use vast amounts of health, social, and economic data with far greater granularity than was previously possible. Yet these fields have largely been siloed, limiting the uptake of evidence-informed solutions to improve the health of vulnerable populations. We need closer coordination across the fields — to leverage all we know and all we can do — for greater impact.

This is the crux of a new report by the Commission on Health Determinants, Data and Decision-making (3-D Commission), an initiative by the Rockefeller Foundation and Boston University School of Public Health. Over the past two years, the 3-D Commission has delved into the key social and economic drivers that influence health outcomes and explored how data on determinants should be integrated into decision-making processes. The findings of the 3-D Commission’s final report are centered around the need to consider the full range of factors, barriers, and opportunities for using data on determinants, and to do so more systematically to inform policies and practices for improving health.

The impacts of social determinants are long-term, dependent on context and other variables. Given the lengthy causal pathway between exposure to some factors and health outcomes — and all the intervening factors along the way — it can be difficult to quantify their effects. This is where the use of data becomes essential. Policymakers must continually connect the dots between epidemiological data and social determinants data to understand fully the health challenges they are facing.

We know that the conditions in which people live affect health throughout the full life course in myriad ways, including increased risk of disease, exposure to potential violence, discrimination and abuse, and economic strife. Access to resources that promote health are highly dependent on the laws and customs of the country, the capacities of the national systems including the health system, and local behaviors. Understanding all of these barriers will allow for improved decision-making, more effective interventions and more equitable allocation of resources. 

The 3-D Commission report provides a useful roadmap for scholars, practitioners and policymakers alike, with recommendations in three focus areas — political will, technical capacity and community engagement — to drive results. Its recommendations are rooted in six principles for action:

1. Evidence-informed decision-making to promote healthy societies needs to go beyond healthcare and incorporate data on the broader determinants of health.

2. All decisions about investments in any sector need to be made with health as a consideration.

3. Decision-making that affects population health needs to embrace health equity — while also acknowledging potential tradeoffs between short- and long-term costs and benefits.

4. All available data resources on the determinants of health should be used to inform decision-making about health. 

5. Data on the social determinants of health should contribute to better, more transparent and more accountable governance.

6. Evidence-informed decision-making to promote healthy societies needs to be participatory and inclusive of multiple and diverse perspectives.

Turning the 3-D vision into reality will require sustained national and international commitments to these principles and recommendations. We must cultivate data-informed decision-making that values and honors lived experiences and perspectives from the same people health policy is intended to help. We must foster community participation in the data collection process, with full transparency, to build trust. The health, safety and wellbeing of millions of citizens hang in the balance.

* Sherine Shawky is a Senior Research Scientist at The Social Research Center, The American University in Cairo.