It is widely acknowledged that health is impacted by far more than just medical care. Housing status, access to healthy foods, ability to secure reliable transportation, and many other social and economic factors play an enormous role in overall health and well-being. In fact, on a weekly basis, I come across a myriad of articles, panel discussions, webinars, and research studies referencing programs and interventions that address the social determinants of health. Or are they social needs?
Social Determinants vs. Social Needs
While the concepts of “social determinants of health” and “social needs” are not new, the terms are now broadly accepted across the health care community. Often the phrases are used interchangeably, which can be problematic as discussed in the recent Health Affairs blog Meeting Individual Social Needs Falls Short Of Addressing Social Determinants of Health and The Millbank Quarterly’s Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems.
Although both issues are incredibly complex, the difference can be simplified to an individual (social needs) versus community (social determinants) level.
Social needs focus on the individual or family. They include real-time gaps that impede one’s health, well-being, and safety. This can include the risk of eviction, access to healthy meals after discharge from the hospital, or transportation to a job or doctor’s appointment. More and more stakeholders across the health care spectrum are taking action to identify an individual’s immediate social needs, often related to food insecurity, housing instability, transportation access, and interpersonal violence. Individuals are then connected with the local resources that can help address their urgent concerns.
The impact of social needs on health conditions has prompted innovative partnerships among health, government, and community stakeholders. One example is the Managing Asthma Triggers at Home (MATH) program, a collaboration between the Summit County Department of Public Health and Akron Children’s Hospital. The MATH project is a year-long program that helps families with children with asthma identify and mitigate asthma triggers in the home. In addition to a comprehensive home assessment, participants can receive a “Clean Home Kit” containing a HEPA vacuum and filter unit, dehumidifier, new furnace filter, and mattress and pillow covers. There are many programs like the Akron, Ohio example that are demonstrating positive impacts through health care cost reductions and lower hospital readmission rates, while also providing critical services to vulnerable individuals. However, they tend to operate at a small scale and focus on high system utilizers. It can be challenging to address the underlying cause or “determinant” that would eliminate the issue altogether.
Social determinants are the systemic forces, policies, and regulations that have long-term impacts on a community. You are probably already familiar with the World Health Organization’s definition of social determinants of health: “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” Social determinants include policies and practices that influence access to services and supports like quality education, employment opportunities, and stable and safe housing.
For example, the long-term impact of redlining—the historic practice of discriminatory mortgage lending practices banned over 50 years ago—still impacts communities today. Many redlined neighborhoods continue to struggle with high poverty rates and lack the social advantages, like access to transportation and healthy foods. A recent study from the University of California showed that individuals living in historically redlined neighborhoods are more than twice as likely as others to go to the emergency room for asthma. While the research shows this may be partly attributed to elevated levels of air pollution in these neighborhoods, the underlying issue of poverty is also a driving force.1
Solving for Both
Addressing the social needs of an individual and the social determinants of a community require different approaches, partnerships, and innovations. Programs that provide food, temporary housing, and transportation are necessary to address immediate social needs. However, efforts that look upstream and attempt to address the systemic factors driving the needs in the first place are also critical.
UnitedHealthcare’s support of and participation in the Aligning Health and Housing Systems Initiative is one example of our commitment to addressing broader social determinants of health. Through our partnership with the Corporation for Supportive Housing (CSH) and Council of Large Public Housing Authorities (CLPHA), we are demonstrating the impact that collaboration and data analysis among non-traditional partners can have on health interventions and outcomes.
We are also excited to participate in the State of North Carolina’s groundbreaking NCCARE360 program, the first statewide network to connect individuals with local resources that address social needs. This innovative program also provides community organizations with tools to better manage and track referral dispositions. The technology platform, social needs screenings, and referral outcomes will enable unprecedented data collection — illuminating community needs and highlighting service gaps. Stakeholders will be able to use this data, along with community feedback, to make strategic infrastructure investments and program enhancements that build local service capacity and begin to chip away at the underlying social determinants of health.
At UnitedHealthcare, we are committed to ongoing learning and engagement in the communities in which we have the privilege to serve. We continue to develop relevant programs and strategies that support our members. With the connection to positive health outcomes so clearly linked to one’s social needs, we continue to look for ways to align community and government partners in identifying and addressing both the social needs and social determinants facing our families and communities.
1. Historic Redlining and Asthma Exacerbations Across Eight Cities of California: A Foray into How Historic Maps Are Associated with Asthma Risk. A. Nardone, N. Thakur, J. R. Balmes; 1UC Berkeley-UCSF Joint Medical Program, Berkeley, CA, United States, 2Univ of California San Francisco, San Francisco, CA, United States