Health care payers and providers must address the social needs of patients to deliver complete care
This is the first post in a four-part series about social determinants of health (SDOH). This post provides an overview of SDOH and frames additional issues in the field. Subsequent posts will focus on data standards for improving the collection and use of SDOH, measuring quality in the context of SDOH, and evaluating programs that address SDOH.
In January 2018, a woman in Baltimore was found outside on a freezing cold night wearing nothing but a hospital gown and socks, having been recently discharged from a local hospital. Video of the event made national headlines, prompting an apology from the hospital and an investigation from the Centers for Medicare and Medicaid Services (CMS). CMS’s reports highlighted a number of deficiencies in the circumstances that led to the woman’s situation, including lack of compliance with the laws that govern emergency departments (ED) and how an informal “un-discharged” function led to inaccurate counting of ED visits and tracking of patient care. Remedying the deficiencies in the report may prevent another incident of inappropriate discharge, but they would do little to address the underlying causes that led to the woman’s plight, including poverty, mental illness, and housing insecurity.
The U.S. health care system was never designed to address the complex social needs that contributed to the events in Baltimore, and there is growing recognition of and research into the ways social factors—often referred to as “social determinants of health”—impact people’s health and well-being. The CDC defines SDOH as “conditions in the environments in which 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,” and the World Health Organization notes that they are the root cause of most health disparities.