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Social Drivers 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 (HRSN), 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 drivers 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 HSRN. A comprehensive set of polices across the federal government, states, and local communities will be needed to address the multiple drivers of health inequities to improve health outcomes for the population as a whole. A focus on SDOH will be an important component of many of these policies.

To support these cross-HHS efforts, ASPE worked with agency partners across HHS to develop Addressing Social Determinants of Health in Federal Programs.

In addition, ASPE is conducting research and analysis in the following areas: