Successfully addressing adverse impacts of SDOH requires
- reaching populations and neighborhoods at high risk for unmet social needs and taking a human-centered approach (getting to know individuals and populations and their deep experiences; showing empathy) to identify and understand the barriers and challenges that give rise to their needs;
- engaging communities, community partners, community clinics, and community-based organizations through an equity lens and building intersectional and sustainable solutions that leverage their strengths and address their unique needs; and
- developing interventions; testing, measuring, and evaluating intervention effectiveness; and scaling and replicating successful interventions.
Social Determinants of Health
Identifying and mitigating non-medical factors that influence health outcomes
Per the U.S. Department of Health and Human Services, “social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Many social risk factors—such as economic insecurity, housing instability, and social needs like food, housing, and transportation—create differences in successful health care, public health, and social care across populations. To address SDOH and advance health equity, community-based public health and health care organizations must partner to eliminate structural barriers and ensure access.
The Centers for Medicare & Medicaid Services’ (CMS) Accountable Health Communities (AHC) Model is working to address the disproportionate adverse impacts of SDOH on racial and ethnic minorities, low-income populations, people with disabilities, and other groups by connecting qualified Medicare and Medicaid beneficiaries who have health-related social needs with community resources.