(WITHDRAWN) Selling the Social Determinants of Health

Background and Purpose: The social determinants of health (SDOH) is a powerful explanatory framework for understanding the systemic factors beyond the individual (e.g., genetics, behavior) that produce health inequities, or avoidable and unjust differences in health status. Now that major health organizations, healthcare, and social service systems, and policymakers embrace the framework’s relevance to health inequities, the SDOH is said to have “come of age" (Braveman, 2011). With this acceptance, private capital has come to see SDOH framework as an opportunity to create products and generate profit. One example is Unite US, a software company that has developed a web-based platform for social service and health organizations to track SDOH at the patient-level and for coordinating social service and health systems. While some research has explored the commodification health disparities research, no equivalent empirical research exists for the SDOH. Using the case of Unite US, this paper investigates how a for-profit company is using the SDOH language and framework to inform and build technologies for corporate financial gain. The current study aims to understand how a software company understands and operationalizes the SDOH. Additionally, the current study asks: how might this technology shape frontline health and social service practice?

Methods: Textual (e.g., press releases) and visual data (e.g., photographs, infographics) were hand-selected from web content, company emails, and webinars. Data were screened for relevance to the study questions and analyzed using conventional content analysis. Texts were coded thematically using Microsoft Word, guided by the principles of grounded theory, critical discourse analysis, and an abductive approach to qualitative analysis.

Findings: Unite US promotes the patient-level, cost-saving, and risk-avoidant aspects of the SDOH framework in both textual and visual data. The SDOH are rendered as measurable, preventable, treatable, and individual. Additionally, findings suggest that Unite US promotes partnerships with private capital (e.g., Lyft, CVS) in ways that may contradict the meaningful engagement with the SDOH and elimination of health inequities. For example . Finally, the analysis suggests that intervening on the SDOH is rhetorically aligned with the tech industry through the deployment of terms such as “reinvention,” “disruption,” “streamlining,” and “return on investment.”

Conclusion and Implications: Findings highlight the relationship between private capital and innovations on the SDOH framework. By examining the frames and discourses deployed by those shaping the SDOH framework in practice and research settings with software products, social work practitioners and scholars can better discern which interventions are more accurately and meaningfully targeting social determinants. These findings also point to an emerging for-profit SDOH industry.