RISE looks at current trends and challenges related to social determinants of health (SDoH) with Melissa Quick, co-chair, Aligning for Health, a coalition advocating to Congress for solutions to address SDoH across the country.
For years community-based organizations and social service organizations have implemented innovative ideas that target SDoH locally, particularly in pockets with strong leadership. However, the federal government can help level the playing field and set a foundation for success throughout the U.S. explained Quick, who co-founded Aligning for Health in 2017.
“We created Aligning for Health with the idea being that we can be advocating to Congress or working with the administration to highlight best practices, examples of cross-sector work occurring across the country, and make sure they’re thinking about SDoH and ensuring programs work best together as they’re doing their policy making and thinking about how to best enable communities for success,” she said.
Since the start of the coalition, Aligning for Health has worked to eliminate barriers in addressing SDoH through direct advocacy of funding and targeted support for communities and states. Here are a few of the current trends, challenges, and congressional approaches the membership association is seeing:
More health care organizations recognize the impact of SDoH on health outcomes
While SDoH and health inequities have always been in existence, they have come to the forefront in recent years, particularly amid the COVID-19 pandemic. The heightened focus on SDoH and health equity has caused an increased interest in the health care space to partner and build out capabilities to better understand the social needs facing individuals and where inequities are occuring, said Quick.
“Over the past couple years, we have noticed there has been a proliferation in health care organizations really taking to heart that SDoH do in fact effect the health outcomes of their populations,” she said, adding that more organizations have started incorporating SDoH into an overarching strategy to determine how to best address the needs of the individuals they serve.
At Aligning for Health, the association has been working with the White House administration and Congress to make sure they realize that health care organizations want to establish connections to address social needs and need support at the federal level to ensure they can work together to address the gaps.
Data sharing, setting up networks remain significant barriers to addressing SDoH
A lack of standardized data and data-sharing capabilities are persistent barriers that interfere with addressing SDoH, explained Quick, not only within the health care sector itself but also between health care organizations, community-based organizations (CBOs), and social service organizations, as most run off different systems, collect information for different purposes, and may not have the capabilities to share that data in an interoperable way. Organizations such as the Gravity Project are working to create and implement standards for organizations to exchange data. “There’s still a lot of room to grow to ensure it can be implemented across the country,” said Quick.
The technology gap between health care organizations and non-health care organizations also poses challenges to setting up networks among health care organizations, CBOs, and social services organizations. While a provider may identify that an individual is struggling with a social need and wants to make a referral to a CBO, the provider may not actually have the ability to make the referral and the CBO may not have the ability to receive a referral or loop back with the provider to confirm it can meet the individual’s need. “It’s great that providers are starting to screen more and also starting to refer, but if the food bank the provider Is referring an individual to has no capacity to meet that individual’s need and the provider doesn’t know that, it doesn’t necessarily solve the problem,” she said.
There are, however, more attempts and incentives for organizations to fully close the loop with referrals as well as build out actual connections, she added. Development in community information exchanges and tech-enabled solutions, such as Aunt Bertha and Unite Us, are striving to bridge the gap.
COVID led to a spike in SDoH funding, other proposed legislations aim to provide funding beyond the pandemic
In the wake of the COVID crisis, there has been a significant amount of funding made available through several COVID relief bills aimed at social needs, such as housing, nutrition, and maternal health outcomes, to build up community level capacity and infrastructure, said Quick. There’s potential for the funding to be made permanent.
Over the past couple of years, Aligning for Health has been working with Congress to pass several bills to provide funding for capacity and resources to address SDoH at a local level. “We’re excited to see some momentum here and a lot of interest across both Congress and the administration of really thinking through how to move the ball forward,” said Quick.
Some of the recent advancements she shared include:
- Parts of The Social Determinants of Health Accelerator Act, a bipartisan bill originally introduced in 2019 and reintroduced this year, were successfully included in the end of year appropriations in 2020, providing the Centers for Disease Control and Prevention with $3 million in funding to establish an SDoH pilot program to award competitive grants to state, local, territorial, or Tribal governments in support of SDoH Accelerator Plans.
- In his budget request for Fiscal Year 22, President Joe Biden requested an increase in the SDoH funding from $3 million to $153 million. The House also matched the amount in its Fiscal Year 22 Appropriations Bill, which representatives passed in July.
- In June, the House Energy and Commerce Committee held a hearing on health equity and public health data systems, which talked in depth about issues related to social determinants and the solutions needed to address them, as well as the initiative to advance several SDoH bills to further the momentum.
- The Congressional SDoH Caucus, the first congressional caucus focused solely on SDoH, launched in July. The caucus aims to better understand and highlight best practices of organizations, entities, and governments seeking to address SDOH across the country; the challenges they’re facing; and what Congress can do to help ameliorate some of those challenges and drive improved health outcomes on the ground to proliferate and be scaled to other areas, explained Quick.