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Social Determinants of Health

Improving health equity in the United States is a priority for the Biden-Harris Administration in order to address longstanding disparities in health outcomes. According to the Centers for Disease Control (CDC), health equity is achieved when every person has the opportunity to attain his or her full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. Health inequities are reflected in differences in outcomes such as rates and severity of disease, quality of life, rates of disability, and length of life. These inequities can also be conceptualized and measured in terms of the drivers of differences in health outcomes. These drivers begin upstream with structural discrimination which results in differences in social determinants of health (SDOH), health-related social needs (HRSNs), access to care, and, finally, differential quality of care within the health care system. Recent efforts to quantify the contributions of different factors to health outcomes suggest that social and economic factors play a larger role than clinical care. For example, the County Health Rankings weights social and economic factors as the largest contributor to overall length and quality of life at 40%, while clinical care (both quality and access) contributes only 20%.

The Department of Health and Human Services (HHS) has focused research and planning efforts on better understanding the social determinants of health inequities and developing policies to improve equity. There is a greater focus on the critical role structural discrimination and racism play in determining the distribution of SDOH and the downstream impact on HRSNs. Multiple agencies across HHS are implementing policies and programs to help facilitate enhanced coordination between health and social care providers to better address unmet HRSNs. However, we recognize that HHS alone cannot achieve the future we envision in which everyone, regardless of social circumstances, has access to aligned, high-quality, person-centered health and social care systems that can improve health and well-being. Achieving this vision requires organizations from different sectors operating within the same community – including partnerships across health care, social services, public and environmental health, government, and health information technology – to come together to address shared objectives.

In Spring 2022, HHS released its strategic approach to addressing SDOH. Speaking to the need for community-driven transformation, HHS is also releasing a Call to Action with the intent of catalyzing efforts at the community-level to encourage partnerships across sectors, including health care, social services, public and environmental health, government, and health information technology to address social needs and improve the health and well-being of every American. This Call to Action is intended to supplement the White House U.S. Playbook to Address Social Determinants of Health which describes actions being taken across the federal government to address SDOH.

In addition, ASPE has conducted research and analysis in the following areas: