Social Determinants and Social Needs: Moving Beyond Midstream

To Improve the Health of Communities, Need to Address Root Causes of Illness, Poverty Along with Individual Impact

An April 9, 2019 Shelterforce article focuses on the need to address the social determinants of health at both the individual and community levels. 

“While individual-level interventions are beneficial, characterizing them as efforts to address social determinants of health conveys a false sense of progress.”

The authors, Brian Castrucci and John Auerbach point to a frayed safety net, economic and housing instability and racism as just some of the factors that are resulting in increasing health care costs and worsening life expectancy. 

“While health care leaders have realized that programs to buy food, offer temporary housing, or cover ridesharing programs are less expensive than providing repeat health care services for their highest cost patients, such patient-centered assistance does not improve the underlying social and economic factors that affect the health of everyone in a community.” 

The State of New Jersey is investing in the social needs of individuals who are homeless through its two-year Housing First pilot program. Under the pilot program, the New Jersey Department of Community Affairs provides 25 tenant-based housing vouchers to people who are homeless and enrolled in the program to help them move into safe and stable housing. And New Jersey hospitals have committed to funding case management. The pilot program is part of a greater initiative within DCA to address chronic homelessness and provide supportive housing throughout the state by partnering with local government entities and hospital systems.

The authors advocate for in conjunction with offering patient-centered assistance also taking  “community-level” policy actions.  These actions would support the critical investments being made by the State of New Jersey and the private healthcare sector in ending chronic homelessness.

Two examples of such policy actions include a ballot initiative in Kansas City, Missouri that fines landlords for not addressing complaints of their tenants.  And a new city tax in Alexandria on meals that funds affordable housing.

“Social needs interventions create a middle stream.  They are further upstream than medical interventions, but not yet far enough. Social needs are the downstream manifestations of the impact of the social determinants of health on the community. Improvements in our nation’s health can be achieved only when we have the commitment to move even further upstream to change the community conditions that make people sick.”

The tactics of clinical medical interventions; addressing individuals’ social needs by asking hospital and emergency department patients about housing and access to food; and improving community conditions by working to institute legislation and policies that improve community opportunities for all are necessary to improve the health of our communities.

Click here the full Shelterforce article.