For those not immersed in health care jargon, the phrases “social determinants of health” or “social drivers of health” may cause you to scratch your head. Even if you work in health care, you might have only vague familiarity with the concept. 

Increasingly, however, all of us in the health care field are called on to understand and address social drivers of health (SDOH, for short). That call is louder and more insistent every day. Hospitals, especially, are being challenged by regulators, public health professionals, advocates, and patients to consider their influence on the underlying social and economic conditions that lead to health and wellness, or lack thereof. 

 

So, what are SDOH?  

SDOH are the non-health care factors that influence our health and well-being. It turns out, over 70 percent1 of our health is influenced by factors outside the health care system. If we only focus on treating people when they come through our doors with illness or injury, we won’t make progress toward improving health.  

The call to action, therefore, is to better understand the underlying factors— like poverty, availability of safe housing and healthy food, education quality, and more—so that we can change the conditions that will lead to greater health and well-being.  

The World Health Organization (WHO) identifies the following as SDOH factors to be aware of:  

  • Income and social protection  
  • Education 
  • Unemployment and job insecurity  
  • Working life conditions  
  • Food insecurity 
  • Housing, basic amenities, and the environment  
  • Early childhood development  
  • Social inclusion and non-discrimination  
  • Structural conflict  
  • Access to affordable health services of decent quality 

 

The Difference between Social Determinants of Health and Social Drivers of Health  

For decades, public health researchers described these as “social determinants of health.” Recently, based on input from patients, some (including the team at Cynosure Health) are evolving to use “social drivers of health” to suggest that these conditions are not fixed and determinative, but indeed can be changed and improved. 

Learn more about this change to Social Drivers of Health here.  

 

What can we do about SDOH? 

Hospitals are experiencing new requirements, pressure, and opportunities to understand and address SDOH, especially for their most vulnerable patients. The Centers for Medicare and Medicaid Services, accreditors like The Joint Commission, along with patients, advocates, and community members are urging hospitals to get serious and strategic about investing in SDOH.  

This charge to focus on underlying conditions that promote health is consistent with the mission of many hospitals and health systems. The vast majority of such institutions express a commitment to promoting to health in their communities. Arguably, one cannot promote health without seriously addressing the conditions that influence health. 

We now have alignment between decades of public health research on the importance of addressing SDOH, and incentives for hospitals and health systems to meaningfully invest in this work. And yet – the bridge between knowing what to do and how to do it is a difficult one to cross. 

At Cynosure Health, we are talking with and learning from hospitals on the frontlines of this work. We’ve hosted brainstorming sessions with hospitals who are building processes to consistently screen patients for SDOH; we’ve built hospital-based social needs indices to translate community-level data to a hospital perspective; and we’ve supported efforts to address disparities in hospital quality metrics in California hospitals. We’ve learned an incredible amount about how we can all move forward together to meaningfully understand and influence SDOH.  

  • The smartest, most efficient way to do this work is to partner with patients and community members. As hospitals develop a deeper understanding of their patients’ lives beyond the hospital walls, they are challenged to think differently about their role in addressing these needs. Hospitals should look to their most valuable partners and sources of information and insight—their own patients—to inform how they talk with patients about social needs or drivers; institute meaningful referral processes; and invest in programs or partnerships that truly meet community needs.  Learn more: Social Drivers of Health (SDOH) Screening Questions
  • This work is new, and hospitals large and small are tackling it head-on. Many hospitals are in the early planning phases, especially related to new requirements to screen patients for SDOH. It is no small undertaking to build processes that account for adequately training staff; documenting information across disparate electronic health records; and ensuring the clinicians who have conversations with patients are creating a compassionate, psychologically safe environment.  
  • Identify and integrate with other resources. Hospitals do not have to do this work alone; in fact, they most definitely should not do it alone. We’ve heard from hospitals who are aligning with and integrating with existing resources, such as health information exchanges, community-based organizations, social service organizations, and regional or state initiatives that are also focusing on SDOH. Before you begin, look around at what already exists and how you can join in and build on the work that’s already begun. 
  • Not all needs will be met, but data shines a light on challenges. We hear often that hospitals, especially when discussing screening for individual SDOH, are concerned that they will not be able to meet all of the needs they identify. This is inevitable and should not stop hospitals from working towards sustainable individual screening processes, or from gaining a deeper understanding of the systemic barriers that exist in their communities. Instead of being discouraged when we identify unmet needs, we must muster the courage to share this knowledge with others and advocate for the resources, policies, and investments that will lead to community-wide improvements in health.  Learn more: Social Drivers of Health (SDOH) Screening Tools

 

While some hospitals have been pioneering efforts to address SDOH for years, many are still very new at both understanding and addressing these needs. We may not get things right the first, second, or third time around, but if we focus on listening to and partnering with patients, families, and our communities, we can make progress toward more equitable health care and outcomes.  

If you’d like to keep the conversation going, we have an active group of over 2,100 members ready to learn and grow together. Join the Social Drivers of Health Community today!