Leveraging the Social Determinants of Health: What Works?

Abstract

We summarized the recently published, peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending. Of 39 articles that met criteria for inclusion in the review, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), health care costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. Our analysis of the literature indicates that several interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have had positive impact in terms of health improvements or health care spending reductions. These interventions may be of interest to health care policymakers and practitioners seeking to leverage social services to improve health or reduce costs. Further testing of models that achieve better outcomes at less cost is needed.

Disruptive Models in Primary Care: Caring for High-Needs, High-Cost Populations

“…57 Better integration of medical, behavioral health, and social service delivery, such as the models currently being tested as part of state waivers for managing dualeligible populations, 58 the Centers for Medicare & Medicaid Services Accountable Health Communities demonstration, 59 and the British Bpersonal health budgets^program, 60 could bolster the ability of health care delivery systems, and primary care clinicians in particular, to meet the needs of HNHC patients. 61 A final challenge for improving care for HNHC populations is that, with a handful of exceptions (some of which were noted in this essay), there are few rigorous studies of HNHC programs. 10 Part of the explanation for this is that evaluating programs for HNHC populations presents unique hurdles.…”

“You Are Not Alone”Strategies for Addressing Mental Health and Health Promotion with a Refugee Women's Sewing Group

“…There is a growing body of literature that reports that social, behavioural, and environmental factors may have a greater impact on population health than medical factors (Taylor et al, 2016). The Centers for Disease Control and Prevention (CDC) cautions that a lack of attention to these social factors creates health disparities and can contribute to poverty, inadequate access to health care, and educational inequalities (2014).…”

Development of the Community Health Improvement Navigator Database of Interventions

“…Non–health care partners might include public health, businesses, the local government, community members, and community-based organizations. These sectors can work together with health systems to create sustained changes that address the root causes of disease, including socioeconomic factors, the physical environment, health behaviors, and clinical care (22). Simultaneous interventions in multiple areas, both within and outside the health care system, have the greatest sustained improvements in community and population health (http://www.cdc.gov/chinav/docs/chi_nav_infographic.pdf).…”