Social Determinants of Heath and the American Drug Price Debate

What are the Social Determinants of Health (SDOH) and what is the seemingly more prominent role they now play in the debate on American healthcare costs? In lieu of actually regulating the prices at which pharmaceutical companies are allowed to sell their drugs to the American market (an outcome that only seems to become more unlikely) the latest strategies being fielded to reduce the overall costs to patients seem to increasingly involve improving the SDOHs. 

Social Determinants to Health, to give its most basic definition (and the one held to by the World Health Organization), are all of the non-medical factors which influence a person’s health outcomes. To continue with the definition given by WHO, “they are the conditions in which people are born, grow, work, live and age.” SDOHs include those factors which can be statistically predicted to have an influence on someone’s general health. They include education, a person’s employment status, a person’s home or family life, and so on. They are largely socioeconomic factors of the kind frequently invoked in predictions of life expectancy and the probability of someone falling ill. But how do they factor into the longstanding issue of American prescription drug prices?

Anything But Charge Less

The emphasis on SDOHs in the current debate on American drug prices is the result of an interesting combination of political circumstances. On the one hand, there is broad consensus that American drugs cost too much. Indeed, it is hard to see how they would not be. Prescription drugs in the U.S. cost on average 2.5 times as much as the same drugs across the healthcare systems of other high-income developed nations. This 250% mark up is staring everyone in the face and cannot be denied. For nearly 20 years, it has been the primary cause for the market boom in Canadian online pharmacies, like Canada Pharmacy, as overcharged Americans look to the north where the government caps the amount pharmaceutical companies charge in order to get drugs as much as 70% cheaper. Everybody, Democrat or Republican, more or less agrees that prices are too high – but that is where the consensus ends. 

It does not seem like there is a great political will in America to reduce prices via active government intervention a la Canada. The result is that all sorts of other strategies are fielded – and that is where the SDOHs come in. Intending to do something – anything – about drug prices except making the pharmaceutical companies charge less, the American government has approved all sorts of initiatives. This includes sanctioning the wholesale importation, by state governments and other large entities, of Canadian drugs. Another strategy is to make efforts to improve patients’ SDOHs. 

SDOHs and Healthcare Costs

Numerous studies have concluded that improving SDOHs can significantly improve a person’s health prospects down the line, and in turn lead to overall savings. Improvements seem to center around social policy, and it might just be that a total unwillingness to make pharmaceutical companies charge less will lead to government funding into this area. There is also the age-old strategy of promoting healthier lifestyles among those most likely to fall ill. 

The thinking behind this is simply that focus should be shifted towards active preventative measures that stop people getting sick in the first place and away from the reactive measures (medication) that treats them when they do. Yet while this may, on the face it, be laudable, it betrays a total unwillingness to do the one thing that would definitely work – making pharmaceutical companies charge less for their drugs.

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