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Health in the United States is not equally distributed; there is a 15-year gap in life expectancybetween the richest and poorest 1 percent of Americans. There is clear evidence that health and health inequities are largely determined by the conditions in which we are born, grow, live, work, and age—the social determinants of health (SDOH). These include education, employment, income, and housing and are in turn shaped by systems that maintain unequal power and privilege, including institutional and structural racism.
In the past decade, interest in SDOH among health care leaders has grown rapidly, and there is an increasing focus on the role that health care can and should play in responding to social needs and tackling SDOH. This has been heightened by the unequal impact of the COVID-19 pandemic and the national social movement for racial equity following the murder of George Floyd.
Health care organizations can act on SDOH at two levels: at the individual patient level and for wider communities, in which beneficiaries include those who may not be patients of the organization. Much of the interest, action, and academic study to date has been on the former, such as through an emphasis on patient-level social screening and referrals to social services. However, sustained improvement in the SDOH is likely to require community-level change. The importance of this work has been emphasized by several national organizations, including the American Hospital Association, America’s Essential Hospitals, and the Association of American Medical Colleges.