Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Abstract

Since 1980, the Healthy People initiative has developed measurable 10-year objectives to guide and evaluate our nation's efforts to improve the health and well-being of all people. Healthy People 2030 includes an overarching goal that focuses on social determinants of health (SDOH): “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”1 As we recover from an unprecedented pandemic, we have an opportunity to leverage recent investments in the US public health system to advance this national SDOH goal. Multisector community partnerships (MCPs) are a key component of the public health approach to addressing SDOH and promoting health equity.2 In 2020, the Centers for Disease Control and Prevention's (CDC's) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), National Association of County and City Health Officials (NACCHO), and Association of State and Territorial Health Officials (ASTHO) launched the Improving SDOH—Getting Further Faster (GFF) initiative, partnering with 42 established MCPs and RTI International to rapidly generate practice-based evidence that could inform and strengthen future community-driven SDOH interventions.3 GFF focuses on 5 SDOH domains with links to chronic disease: (1) built environment, (2) community-clinical linkages, (3) food and nutrition security, (4) social connectedness, and (5) tobacco-free policies. This column provides a progress update on the GFF initiative, including a brief description of ongoing work to illuminate opportunities for health departments and health care systems to support community-driven SDOH interventions. In the first year of the GFF rapid retrospective evaluation, we identified key achievements and estimated the potential long-term impacts of MCPs' SDOH interventions. Retrospective evaluation findings indicated these partnerships helped increase their communities' capacity to implement SDOH interventions; contributed to policy, systems, and environmental changes that support healthy living; and helped improve chronic disease–related outcomes among community members.4 Prevention Impacts Simulation Model (PRISM) analysis results estimated that sustained interventions could potentially save more than $560 million in productivity and medical costs cumulatively through 20 years.4 These findings yielded actionable insights for funders and technical assistance (TA) providers, including the importance of promoting and providing resources to support meaningful community engagement. Year 2 GFF Approach Our initial evaluation identified the need to better understand the specific roles health departments have in supporting GFF MCPs' SDOH interventions, particularly the factors that facilitate and challenge the partnerships. In the second year of GFF, we are partnering with a subset of the initial cohort to continue qualitative discussions and generate practice-based evidence on the specific roles health departments play in addressing SDOH. Fourteen GFF MCPs were identified on the basis of their experience collaborating with health departments and documenting outcomes for SDOH interventions. As in the first year, the cohort covers all of the 5 areas of SDOH (4 built environment interventions, 9 community-clinical linkages, 7 food and nutrition security, 4 social connectedness, and 5 tobacco-free policy). Similar to year 1, we are conducting a review of program documents, including progress reports to funders and evaluation reports, to summarize MCPs' reported community change and health outcomes. Information on reported outcomes will be incorporated into additional PRISM analysis, and year 2 PRISM analysis will account for intervention costs, to the extent data allow. Health Departments and Multisector Community Partnership Efforts State, local, and territorial health departments are tasked with assessing and ensuring the health of their communities and are thereby important partners and/or leaders of SDOH activities. Health departments routinely lead community health needs assessments (CHNA) and develop community health improvement plans (CHIP) with a variety of partners. These products help engage community members and organizations on public health issues and provide information for understanding and prioritizing intervention needs. Increasingly, these CHNA and CHIP include SDOH as specific focus areas. Health departments are uniquely positioned to help communities gather more actionable local data; identify and promote evidence-based practices that can meet intervention needs; and communicate needed policy, systems, and environmental changes to state and local decision makers. Indeed, GFF findings to date indicate that health departments are supporting community-driven SDOH interventions through the provision of technical assistance and funding and by connecting community organizations with shared missions. In addition to illuminating real-world models of health department and MCP collaborations, year 2 evaluation work will also focus on refining a set of measures that can be used to monitor and evaluate public health approaches to addressing SDOH. Addressing the Evolving Landscape Early this year, the Centers for Medicare & Medicaid Services passed a rule requiring hospitals to integrate social needs screening by 2024.5 While some hospitals and health care systems have historically invested in social needs and upstream SDOH, the rule is clearly changing the landscape. Screening is an important initial step in identifying and addressing unmet social needs, but it will necessitate partnerships between health care, health departments, and community organizations to address the varied social needs of patients and identify what resources are available in the community. In addition, the terms “SDOH” and “social needs” are widely used across both the public health sector and health care community, oftentimes interchangeably, despite being quite different. Addressing the social needs of an individual is necessary but insufficient to address the broader social determinants of a community.6 For example, a housing voucher could provide an individual with safe, healthy housing. However, if there is low to no inventory of available, affordable housing in the community, the individual will not be able to redeem the voucher. Addressing both will require different strategies, partnerships, and innovations. An important next step of the initiative will be to evaluate the role of health departments and the health care systems as part of MCPs to address needs of individuals as well as the broader SDOH. Conclusion New and significant investments in public health infrastructure present an opportunity to advance the Healthy People 2030 SDOH goal to “create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.” Progress on this SDOH goal is critical for advancing health equity. As changes occur in the health care delivery system, it is important to understand the connections to public health and community organizations. Practice-based evidence on how partnerships are successfully addressing and improving SDOH—including the resources and supports needed to help them overcome common implementation challenges—can help funders, TA providers, and partnerships leverage new investments in SDOH efforts for public health and health care systems. We hope insights gained in our second year of the GFF retrospective evaluation will help community partners, health departments and health care realize the benefit of their coordinated and complementary initiatives to maximize improvements in SDOH.