Office of the Assistant Secretary for Planning and Evaluation (ASPE) release
Social determinants of health (SDOH) are the conditions where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes.
This release includes three documents that: (1) explain why HHS has identified addressing SDOH as a major priority for the Department; (2) describe HHS’ strategic approach, and specific actions the Department is taking to address SDOH; and (3) link how these actions build on evidence in the field on what works.
A. The first document is an essay in the Journal of the American Medical Association (JAMA) Health Forum that describes HHS’ three-pronged strategy to address SDOH through: (1) enhancing data infrastructure; (2) improving connections between health and social service providers; and (3) engaging in whole-of-government collaborations to implement comprehensive solutions.
Addressing Social Determinants of Health in Federal Programs https://jamanetwork.com/journals/jama-health-forum/fullarticle/2790811
B. The second document is a supplemental two-page summary and infographic that summarizes the HHS SDOH strategic approach.
SDOH Action Plan At a Glance https://aspe.hhs.gov/sites/default/files/documents/aabf48cbd391be21e5186eeae728ccd7/SDOH-Action-Plan-At-a-Glance.pdf
C. The third document [30 pages] is a review of the evidence on interventions that have been implemented to address social determinants of health and describes illustrative HHS agency actions.
Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts
Long-standing health inequities and poor health outcomes remain a pressing policy challenge in the U.S. Studies estimate that clinical care impacts only 20 percent of county-level variation in health outcomes, while social determinants of health (SDOH) affect as much as 50 percent. Within SDOH, socioeconomic factors such as poverty, employment, and education have the largest impact on health outcomes.
SDOH include factors such as housing, food and nutrition, transportation, social and economic mobility, education, and environmental conditions. Health-related social needs (HSRNs) refer to an individual’s needs that might include affordable housing, healthy foods, or transportation. This report provides select examples of the evidence in several of these areas.
Housing– Studies show strong evidence of the benefits for “housing first” interventions that provide supportive housing to individuals with chronic health conditions (including behavioral health conditions). Benefits include improved health outcomes and, in some cases, reduced health care costs. In addition, interventions that reduce health and safety risks in homes, such as lead paint or secondhand smoke, can also improve health outcomes and reduce costs.
Food and Nutrition – Efforts to improve food access through healthy food environments, public benefit programs, health care systems, health insurers, and evidence-based nutrition standards can lower health care costs and improve health outcomes.
Transportation– Enhanced built environment interventions including sidewalks, bicycle infrastructure, and public transit infrastructure can make physical activity easier, safer, and more accessible. Non-emergency medical transportation has been shown to be cost-effective by increasing use of preventive and outpatient care and decreasing use of more expensive care.
Social and Economic Mobility – Multiple randomized trials show that cash payments to families and income support for low-income individuals with disabilities are associated with better health outcomes. Early childhood care and education are also associated with positive health outcomes.
Social Service Connections – Some studies of care management and coordination using multidisciplinary teams that support HRSNs show reduced total cost of care and improved health outcomes, but the evidence overall on these effects is mixed.
Building on this evidence base, the U.S. Department of Health and Human Services is taking a multifaceted approach to address SDOH across federal programs through timely and accessible data, integration of public health, health care, and social services, and whole-of-government collaborations, in order to advance health equity, improve health outcomes, and improve wellbeing over the life course.