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When it comes to community health, social determinants of health play a critical role. Is a relatively healthy population more likely to be plagued by diabetes or depression? Can a wealthy community anticipate its odds for breast cancer? Why do counties with a highly educated population suffer from a high rate of hyperactivity diagnoses? A recent report prepared by Moody’s Analytics for Blue Cross Blue Shield Association (BCBSA) takes a crucial next step in population health management by identifying the social determinants of health that have a significant impact on the health of communities as a whole. This new report combines the Blue Cross Blue Shield Health IndexSM (BCBS Health Index) with a custom analysis to study the breakdown of just how large– or how small – a role certain social determinants play in the level of health in various communities.

The BCBS Health Index

The BCBS Health Index is a unique measurement of America’s health that quantifies how a range of diseases and conditions impact longevity and quality of life. The BCBS Health Index leverages 1.8 billion claims for more than 40 million commercially insured Americans under 65, excluding Medicare and Medicaid, over a four-year period. The “health impact” of a specific condition is the degree to which it reduces optimal health. The Health Index reflects prevalence and severity for that condition as well as the years of life lost due to premature death and disability. For further information on the BCBS Health Index, go to

Health conditions
The BCBS Health Index pinpoints 10 key health conditions that impact communities. From these conditions, the report shows a break in three distinct groupings – physical, mental and unique health conditions – based on how sensitive each is to the impact of various social determinants.

The physical health conditions include high cholesterol, coronary artery disease, hypertension, chronic obstructive pulmonary disease, and diabetes, and paint a fairly standard picture of public health. The variations of the physical health conditions in each county almost directly correlate with a county’s Health Index score and are easily explained by socioeconomic, demographic and behavioral factors. It is also important to note that of the top five national health conditions, three are physical health conditions. That said, addressing these conditions should remain a top public health priority, as they are significantly predictable and preventable through education and behavior modifications.

Mental and unique health conditions are not so easily explained. Mental health conditions do not directly or indirectly correlate with other conditions, as they are not as obvious to diagnose and treat. While it is apparent that specific factors appear to have a certain impact on the physical conditions, mental health conditions don’t seem to follow a clear variation pattern. Furthermore, while certain factors drive the unique health conditions (lung and breast cancer and substance abuse), the rules are not hard and fast and each condition warrants a case by case approach.  

The drivers
So how can a certain location predict a propensity for certain conditions? This is where social determinants come into play. Socioeconomics and demographics, behavior and other health system factors are all linked to a community’s health outcomes to varying degrees. However, it is socioeconomics and demographics that consistently explain the health of each county: “For the overall BCBS Health Index, these variables alone can explain 64% of the variation compared with 74% using all of the variables.”

Furthermore, behavioral factors outrank health system factors in a majority of conditions and “appear to matter most for conditions that are driven by overall population healthiness, in particular, those in the physical health conditions group.” This provides further proof that incentivizing wellness is essential to fostering a healthy population.

These findings present a unique opportunity for both health plans and employers looking to close gaps in care and improve health outcomes through screenings and at-home health testing programs. As a general rule, education and healthy behaviors will yield overall healthiness in communities. This report reinforces the importance of recognizing the factors that impact population health in order to create a targeted, effective programs that improve health outcomes and drive positive behavior changes.

To learn how BioIQ can help you create a health testing program that addresses the specific needs of your population, contact (888) 818-1594 or


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