Federal Government Issues Social Determinants Report

Last week the U.S. Department of Health and Human Services (HHS) issued a Call to Action to address the social determinants of health, that is, the social and economic conditions that have a significant impact on the health and wellbeing of the residents of the nation. These conditions are illustrated visually by the following chart from the federal government’s US Healthy People 2030.  

This unprecedented call to action from a federal agency is directed towards those both in government and in the private sector. It highlights specific steps that can be taken to create health and social services that tackle the negative effects of these conditions. In particular, the report encourages action at the community level with multi-sector partnerships united in what it refers to as “hubs.” Such coalitions would include representatives from the affected communities along with those from such sectors as housing transportation, health care, the environment, and business, as well as public health. 

Building on past and current efforts 

While the report elevates the importance of the issue, the topic of the social determinants of health (SDOH) is hardly a new one: Federal agencies have increasingly focused on this in the last few years. President Biden’s Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, directed federal agencies to implement plans to promote advanced equity, civil rights, and racial justice. Many include a SDOH focus with a potential impact on the content of future grants and contracts.   

More recently, the Office of the Assistant Secretary for Health (OASH) leads the Healthy People 2030 initiative mentioned above. It establishes a SDOH framework that includes national targets to be achieved by the end of the decade, and offers SDOH literature summaries that provide a snapshot of the latest research related to specific SDOH. 

Other examples of the federal government’s commitment to the issue include the CDC’s Closing the Gap with Social Determinants accelerator grants, the Administration for Community Living’s (ACL) oversight of the Housing and Services Resource Center (HSRC), a partnership between HHS and the U.S. Department of Housing and Urban Development (HUD) and CMS’s use of Using Z Codes: The SDOH Data Journey to Better Outcomes in clinical care to better collect and use standardized SDOH data. And to assist in better understanding the issue, the Agency for Healthcare Research and Quality has developed a SDOH Database that collects standardized community-level SDOH data from multiple public sources to analyze community-level variation and inform efforts to improve both health and equity.  

HHS issued other materials related to SDOH earlier this year. In April 2023 it released an article intitled “Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts” which offered numerous examples of current federal SDPH-related activities and highlighted those sectors where the evidence was strongest regarding their impact on health, such as housing and transportation.   

It is not just HHS where there has been increasing attention to social determinants. That kind of partnership was on display at the recent American Public Health Association (APHA) Annual Meeting & Expo, with multiple sessions linking different sectors to collaborate with the goal of improving the health and wellbeing of the nation’s residents. For example, there was a session highlighting the link between health and transportation. Deputy Assistant Secretary Veronica Perry McBeth from the Department of Transportation highlighted the many efforts to consider health as her agency distributes billions of dollars in funding to redesign and rebuild the nation’s transportation system. On the same panel, ICF 's Joseph Yawn and Atlanta Regional Commission’s Director Anna Roach described their work to assist communities as they expanded mass transportation, made communities more walkable and bikeable, and strove to limit exposure to vehicular particulate matter. 

HUD is another non-HHS department that has recognized its role in the promotion of health and wellbeing.  It has created specialized housing for those with disabilities and significant health concerns, supported initiatives to eliminate homeless encampments with public health approaches, and supported home-based services to reduce environmental factors that may trigger asthma. ICF moderated a panel at this year’s annual meeting of the National Association of County and City Health Officials (NACCHO) that highlighted such work with panelists from both HUD and local health departments. 

Building a healthier future 

But the HHS call to action issued last week goes further than past efforts. It lists a series of actions steps that can be taken by those within the federal government as well as in different sectors. It strongly supports the concept of the community care hub, which could bring together a wide range of organizations to address specific local issues through unified planning and improved coordination between health and social care providers. 

It also identifies focused action steps for multiple types of organizations, including: 

• Community-based organizations Such grassroots organizations are encouraged to participate in community hub meetings and, in the absence of existing hubs, help to create and possibly lead such collaboratives. 

• Health care clinicians Doctors, nurses, and other clinicians are encouraged to routinely screen patients for health-related social needs and join community-based hubs with the goal of meeting identified needs. Such action will be advanced as new federal policies are implemented. In 2024, CMS will require hospitals to screen for and report on certain social determinants in certain settings. 
• Payers State-based Medicaid programs are encouraged to consider paying for certain non-medical home and community-based services as potentially allowable with 1115 waivers. Medicare Advantage organizations are encouraged to consider providing special supplemental benefits such as ones related to transportation and food for certain chronically ill beneficiaries.    
• Public health State, local, tribal, and territorial public health agencies are encouraged to create and/or join community-based hubs, link their SDOH-related programs to system-wide referral networks, and utilize their evaluation and evidence-building skills to identify optimal ways to address identified needs. Given their expertise in data collection and analysis, they are encouraged to incorporate socio-economic data into their community health needs assessments and reporting.   

The release of this call to action is one more indication that attention to the impact of social determinants on the health of members of the public is likely to increase. Such practices as multi-year grants, changes in payment and programmatic policy, and incorporation of both the rationale and the long-term cost and health benefits into scores of federal, state, and local strategic plans and official documents will move SDOH approaches into the DNA of governmental functioning.

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