Social Determinants Of Health Model Research Articles

Establishing spirituality as an intermediary determinant of health among 42,843 children from eight countries

The World Health Organization (WHO) Commission on the Social Determinants of Health (CSDH) conceptual framework identifies socio-economic position as a structural determinant of health. Recognized intermediary determinants include biological, behavioural, and psychosocial factors. We examined whether connections afforded by a healthy spirituality potentially act as unrecognized intermediary determinants in adolescent populations, contributing to inequities in mental health. Reports from 42,843 children (21,007 boys, 21,836 girls) from eight countries who participated in the 2017–2018 Health Behaviour in School-aged Children (HBSC) study were used to describe correlations between family affluence and positive levels of mental health, using a cross-sectional design. Based on the CSDH conceptual framework and multivariable regression analyses, we then examined whether these associations were mediated by spiritual health. Connections afforded by a high level of spiritual health were universally correlated with positive mental health status. In three Western European nations (England, Scotland, and Wales) and Canada affluence was correlated with better mental health and this was partially mediated by spiritual health. Among the four Eastern European countries (Latvia, Lithuania, Moldova, Poland), our findings did not support aspects of the CSDH framework that focus on affluence as a direct determinant of health. Spiritual health potentially is an intermediary determinant of children's health in some Western countries, but not in Eastern countries. The universality of social determinants of health models and the measures used in their evaluation require careful assessment across cultures, political contexts, and health outcomes.

SOCIAL DETERMINANTS AND HEALTH EQUITY AMONG NYC OLDER ADULTS

Abstract Of the vast opportunities in New York City, older adults from racial/ethnic minority groups face the challenges of social determinants on their health. This study applies the WHO’s Commission on Social Determinants of Health model to examine health inequities among older adults in New York City. A deeper understanding of interrelationship between structural and intermediary determinants is crucial to promoting successful aging in an urban environment. Data were extracted from the NYC Community Health Survey to focus on older adults, aged 65 and over (N=1,921). Weighted, limited information regression models were used to test the contributions of structural and intermediary determinants on self-reported daily activity difficulties and self-reported health. The sample comprised of 46% Non-Hispanic White older adults, 20% Black/African American, and another 20% Hispanic. One third of the sample endorsed being in poor health. One in 5 older adults reported having a daily activity difficulty. Multivariate analyses showed Black older adults reported more difficulties with daily activities compared to non-Hispanic Whites. Meanwhile, Hispanic older adults reported being in poor health less frequently than non-Hispanic Whites. Further limited information modeling shows the centrality of daily activity limitations on poor health such that the indicator partially mediates the relationship between race/ethnicity and poor health. Overall, the results reveal a fuller picture of the impact of social determinants on health equity among older adults in New York City. Future research needs to specify the sociocultural and economic dimensions of health equity to provide empirical results that can inform practice and policy.

Association between gene methylation and experiences of historical trauma in Alaska Native peoples

BackgroundHistorical trauma experienced by Indigenous peoples of North America is correlated with health disparities and is hypothesized to be associated with DNA methylation. Massive group traumas such as genocide, loss of land and foodways, and forced conversion to Western lifeways may be embodied and affect individuals, families, communities, cultures, and health. This study approaches research with Alaska Native people using a community-engaged approach designed to create mutually-beneficial partnerships, including intentional relationship development, capacity building, and sample and data care.MethodsA total of 117 Alaska Native individuals from two regions of Alaska joined the research study. Participants completed surveys on cultural identification, historical trauma (historical loss scale and historical loss associated symptoms scale), and general wellbeing. Participants provided a blood sample which was used to assess DNA methylation with the Illumina Infinium MethylationEPIC array.ResultsWe report an association between historical loss associated symptoms and DNA methylation at five CpG sites, evidencing the embodiment of historical trauma. We further report an association between cultural identification and general wellbeing, complementing evidence from oral narratives and additional studies that multiple aspects of cultural connection may buffer the effects of and/or aid in the healing process from historical trauma.ConclusionA community-engaged approach emphasizes balanced partnerships between communities and researchers. Here, this approach helps better understand embodiment of historical trauma in Alaska Native peoples. This analysis reveals links between the historical trauma response and DNA methylation. Indigenous communities have been stigmatized for public health issues instead caused by systemic inequalities, social disparities, and discrimination, and we argue that the social determinants of health model in Alaska Native peoples must include the vast impact of historical trauma and ongoing colonial violence.

Utilizing the Social Determinants of Health Model to Explore Factors Affecting Nurses' Job Satisfaction in Saudi Arabian Hospitals: A Systematic Review.

The purpose of this systematic review was to explore factors affecting nurses' job satisfaction in Saudi Arabian hospitals by utilizing the social determinants of a health model. We conducted a systematic review using three databases (PubMed, PsychINFO, and CINAHL) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. A total of 235 studies were screened. Of these studies, nine met the inclusion criteria. The studies were appraised using the Joanna Briggs Institute checklist tool. The majority of studies reported that salary, years of experience, nationality, and marital status were factors affecting nurses' job satisfaction. Gender and educational level did not impact job satisfaction for male and female nurses. Overall, the review highlighted some knowledge gaps in the assessment of the impact of social determinants of health regarding gender and educational level on nurses' job satisfaction. Further research is needed to address this knowledge gap.

Utilizing Social Determinants of Health Model to Understand Barriers to Medication Adherence in Patients with Ischemic Stroke: A Systematic Review.

Ischemic strokes and their recurrence create an immense disease burden globally. Therefore, preventing recurrent strokes by promoting medication adherence is crucial to reduce morbidity and mortality. In addition, understanding the barriers to medication adherence related to the social determinants of health (SDoH) could promote equity among persons with ischemic stroke. To explore the barriers to medication adherence among patients with ischemic stroke through the SDoH. This systematic review included studies published between January 2018 and December 2022 identified through PubMed, MEDLINE, Web of Science, and CINAHL Plus Full Text. The descriptions of the studies were systematically summarized and discussed based on the SDoH from the US Healthy People 2030 initiative. Eight studies met the inclusion criteria and were included in this review. The most common barrier to adherence was inappropriate medication beliefs, medication side effects, and patient-physician relationship, which relate to the dimensions of healthcare access and quality. Health literacy and health perception, dependent on education access and quality, frequently influenced adherence. Other social determinants, such as financial strain and social and community context, were found to alter adherence behaviors. No study addressed the neighborhood and built environment domain. We found that cognitive impairment is another factor that impacts adherence outcomes among stroke patients. Multifaceted approaches are needed to address the SDoH to improve medication adherence among patients with ischemic stroke. This review emphasized strategies, including patient education, provider-patient communication, social support, health literacy, technology, and policy advocacy to enhance adherence.

Https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/261309

During pregnancy, women are exposed to various psychosocial stressors that affect their quality of life, but few studies have looked at them additively in non-western contexts. This study aimed to assess the shared and unique contributions of perceived stress, financial strain, intimate partner violence, food insecurity, and social support to maternal quality of life. Data were gathered from a cross-sectional sample of 519 pregnant women who received antenatal care at various primary health care centers in Ibadan, Nigeria. Independent effects of and two-way interactions between psychosocial stressors in predicting maternal quality of life were explored using hierarchical linear regression. Higher scores for the main effects of food insecurity (β = -0.52, p < 0.01) and social support (β = 0.11, p < 0.01) were most strongly linked to a lower and better quality of life, respectively. Further, the two-way interaction effects were significant for financial strain in combination with intimate partner violence (β = -0.18, p < 0.01) and food insecurity in combination with social support (β = 0.18, p < 0.01) contributing to lower quality of life. The findings of this study were supported by the social determinants of health model, which recognizes that a person’s socioeconomic environment and psychosocial state affect his or her health and life experiences. It is recommended that health care practitioners should incorporate assessments of clinical factors of gestation with those of psychosocial needs as part of routine antenatal care in order to develop appropriate women-centered interventions.

HEALTHY PEOPLE 2030 AND HEALTHY AGING

Abstract The US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (ODPHP) sets science-based health promotion and disease prevention objectives for the nation with 10-year targets through the Healthy People Initiative. In addition to objectives specific to older adults, many of our population-based objectives in other condition-specific topics also contain data for older adults. Healthy People also developed the Department of Health and Human Service's Social Determinants of Health model. This presentation will highlight ODPHP's policy initiatives and campaigns specifically for older adults, including the Dietary Guidelines for Americans 2020-2025, Move Your Way © for Older Adults and provide an update on the Physical Activity Guidelines Midcourse Report on Older Adults.

67-OR: Measures of Social Determinants of Health and Risk of Incident Type 2 Diabetes

Introduction: Social determinants of health (SDOH) impact well-being. We tested the association between incident diabetes risk and SDOH using 2 measures, the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) . Methods: We examined 2015-2021 medical and claims data from the UC Data Warehouse for overweight/obese adults (age>18 yrs; BMI>25 kg/m2; >23 if Asian) . We ran 4 cox proportional hazards regression models with an outcome variable of incident diabetes; 1) base model with age, sex, race, ethnicity, income, BMI, prediabetes and comorbidities, 2) base model + ADI, 3) base model + SVI, and 4) base model + ADI and + SVI. Since SDOH indices were missing for ∼17%, we added them using an interaction term with an indicator variable. Results: Among 36,946 adults, 33,587 (91%) had >1 follow-up assessment. Among these, mean age was 43 yrs, BMI 28 kg/m2, ADI 3.9 (SD 2.4) , SVI 0.34 (SD 0.24) ; 14% had prediabetes. Over 4.6 (SD 3.3) mean follow-up yrs, 715 (2%) developed diabetes. In the base model, incident diabetes risk significantly increased with each additional yr of age (HR 1.03) , unit BMI (HR 1.09) , prediabetes (HR 2.2) , and in Asian (HR 1.5) or other/multi-racial groups (HR 1.6) compared to Whites; risk decreased with hyperlipidemia (HR 0.72) . These associations were significant in all SDOH models (base +ADI, +SVI or +both) . In our SDOH models, incident diabetes risk was not associated with the degree of area deprivation or social vulnerability. However, diabetes risk decreased if ADI estimates (HR 0.54 95%CI 0.38, 0.77) or SVI estimates (HR 0.48 95%CI 0.36, 0.63) were present (vs. undetermined/unknown) . In the SDOH model with both ADI/SVI, diabetes risk decreased if SVI was present (HR 0.49 95%CI 0.34, 0.70) . Conclusion: In our real-world cohort of overweight/obese adults, the degree of area deprivation or social vulnerability was not associated with risk of incident diabetes when traditional risk factors were available. More studies of SDOH measures are needed to inform national diabetes prevention efforts. Disclosure K.Ramm: None. C.Mangione: n/a. T.Moin: None. N.Jackson: None. U.Chung: None. O.Duru: None. K.Shedd: None. S.Soetenga: None. T.B.Loeb: None. D.Elashoff: None. A.B.Hamilton: None. Funding NIH/NIDDK 1R01DK124503

The association between educational attainment and SCA 3 age of onset and disease course

BackgroundThe number of trinucleotide CAG repeats is inversely correlated with the age at onset (AAO) of motor symptoms in individuals with Spinocerebellar Ataxia type 3 (SCA 3) and may be responsible for 50%–60% of the variability in AAO. Drawing from a social determinants of health model, we sought to determine if educational attainment further contributes to the AAO and motor symptom progression of SCA 3. MethodsWe performed a retrospective chart review in which twenty individuals met criteria for inclusion and had been seen by an ataxia specialist at our hospital between January 2005 and July 2019. AAO of motor symptoms and Scale for Assessment and Rating of Ataxia (SARA) scores were used as primary outcome measures. ResultsUsing a linear regression, we found that having greater CAG repeat length and greater than 16 years of education results in an earlier AAO. The importance of the CAG repeat length on AAO, however, is greater amongst individuals with lower education. Using a linear mixed model evaluating SARA score over time with AAO, we found that less than 16 years of education is associated with faster progression of the disease. ConclusionIn our group of SCA 3 patients, level of education correlated with both the AAO and SARA scores. Though our findings need to be confirmed with a larger cohort, our study suggests that level of education can have a strong influence on health outcomes in SCA 3 and possibly other groups of patients with ataxia.

A holistic health determinants model for public health nursing education and practice.

Baccalaureate nursing graduates (BSNs) in the 21st century need to be prepared to manage the population health needs of diverse populations across the lifespan and take actions to improve health equity. A need for a Holistic Health Determinants Model that included the Social Determinants of Health was identified. A model incorporating the Healthy People 2020 Health Determinants Model and the Healthy People 2030 Social Determinants of Health Model was developed. Two theoretical approaches provided a foundation for the model. Social ecological theory stresses the lived experience in an ever-changing environment from the micro to the macro biological, behavioral, social and physical environmental levels. Public health intersectionality added the construct of constant interactions among the health determinants that resulted in different levels of health status among individuals and groups. This Holistic Health Determinants Model is a tool to use in teaching nursing students how to address the needs of individuals/families, diverse populations, and communities. It also facilitates integration of the new AACN Population Health Competencies across the curriculum. The model facilitates the preparation of BSN graduates to address the factors that shape health status and to take actions to improve health equity.

Social determinants of health that permeate the mental suffering of children on the french-brazilian border

ABSTRACT Objectives: to understand the determinants involved in the mental suffering of schoolchildren on the French-Brazilian border. Methods: a qualitative study was conducted with children from 6 to 12 years of age from four State schools in the municipality of Oiapoque, located on the French-Brazilian border. The data were obtained through interviews, analyzed by the IRAMUTEQ software, and interpreted in the light of the Dahlgren and Whitehead’s social determinants of health model. Results: data indicate that the mental suffering experienced by children, especially characterized by anxious symptoms, such as concern of becoming fat and worries, were permeated by social situations that children went through daily, such as family abandonment, domestic violence, and bullying. Final Considerations: social determinants can be predictors of mental suffering in children, especially in environments of extreme vulnerability, such as the border, in a context of financial difficulties, domestic violence, and absence of parenting.

The connection between wildlife co-management and indigenous well-being: What does the academic literature reveal?

Globally, co-management systems have emerged as negotiated agreements designed to share responsibilities among Indigenous Peoples and State governments for the management of fish and wildlife. Co-management practitioners and policies regularly make decisions that influence the ways in which Indigenous Peoples interact with the lands, waters, and natural resources. The goal of this systematic critical review was to characterize the ways in which published research on co-management governance systems in Canada did or did not explicitly engage with Indigenous Peoples’ health and well-being as a key focus. ProQuest®, Web of Science™, and JSTOR® databases were searched to identify literature published from 1973 to 2020 about co-management systems in Canada. The citations and articles were screened for relevance by two independent reviewers, using inclusion criteria developed a priori. Relevant articles were analyzed descriptively and qualitatively, using a health and well-being framework developed as an analytical framework for this study by integrating key attributes from three Indigenous social determinants of health models in Canada. The search resulted in 9,905 citations; 74 publications met the inclusion criteria and were analyzed. None of the included publications explicitly analyzed co-management from a public health or well-being lens; however, social determinants of health topics were implicit, prevalent, and connected to co-management throughout the literature. Social determinants of Indigenous Peoples’ health, such as land and ecosystems, food systems and security, Indigenous knowledge systems, culture, self-determination, and colonialism, were frequently represented in the co-management literature, even if not directly framed by the authors from a health perspective.

The social and structural determinants of sexual and reproductive health and rights in migrants and refugees: a systematic review of reviews.

The sexual and reproductive health and rights (SRHR) of migrants and refugees present important public health challenges. Social and structural determinants affect both the general health and SRHR of migrants, but the drivers of SRHR among migrant and refugee populations remain understudied. To identify upstream social and structural determinants of SRHR health of migrants and refugees reported in systematic reviews. We conducted a systematic review of reviews. We studied 3 aspects of SRHR: sexually transmitted infections, sexual violence and unintended pregnancy in migrants and refugees. We used an inductive approach to synthesize emerging themes, summarized them in a narrative format and made an adapted version of Dahlgren and Whitehead's social determinants of health (SDH) model. We included 12 systematic reviews, of which 10 were related to sexually transmitted infections, 4 to sexual violence and 2 to unintended pregnancy. We identified 6 themes that operate at 4 different levels in an adapted version of the Dahlgren and Whitehead SDH model: economic crisis and hostile discourse on migration; limited legal entitlements, rights and administrative barriers; inadequate resources and financial constraints; poor living and working conditions; cultural and linguistic barriers; and stigma and discrimination based on migration status, gender, sex and ethnicity. This review provides evidence of how upstream social and structural determinants undermine the SRHR of refugees and migrants. Unless these are addressed in policy-making and planning, the health of migrants and refugees is at risk.

Social determinants of health impacting adherence to diabetic retinopathy examinations

IntroductionThis study evaluates the association of multidimensional social determinants of health (SDoH) with non-adherence to diabetic retinopathy examinations.Research design and methodsThis was a post-hoc subgroup analysis of adults with diabetes...

Impact of COVID-19 on Latinos: A Social Determinants of Health Model and Scoping Review of the Literature

The purpose of this scoping review of the literature was to analyze the impact of the COVID-19 pandemic on the living conditions of Latinos (Hispanics) in the U.S. from a social determinants of health perspective. We developed a conceptual model based on the social determinants of health framework to guide the search, extraction, analysis, and interpretation of the bibliographic material. A systematic review of peer reviewed literature published in 2020 in scientific journals in the social, health, and behavioral sciences was conducted. A total of 37 articles met the selection criteria, 12 were original investigations with primary data collection, and 25 were studies reporting results of secondary data analysis using public or private databases. The representation of Latinos in the study samples ranged from 5% to 40%. The results of our review are compelling in terms of the overrepresentation of Latinos in SARSCoV-2 positivity and COVID-19 morbidity and mortality rates. The risk factors identified include working in a job considered essential, living in a geographic area with a high population density of Latinos and blacks, overcrowded living conditions in the household, limited English proficiency, and being unable to systematically carry out preventive behaviors known to be effective for infection avoidance. Existing national surveys and registries suffer from assumptions and omissions regarding variables relevant to Latinos. New studies must be guided by inquiries on the usual social determinants of health, but also those relevant for Latinos, such as national group, generational status, and language, among others.

Social determinants of multimorbidity in Jamaica: application of latent class analysis in a cross-sectional study

BackgroundNon-communicable disease (NCD) multimorbidity is associated with impaired functioning, lower quality of life and higher mortality. Susceptibility to accumulation of multiple NCDs is rooted in social, economic and cultural contexts, with important differences in the burden, patterns, and determinants of multimorbidity across settings. Despite high prevalence of individual NCDs within the Caribbean region, exploration of the social epidemiology of multimorbidity remains sparse. This study aimed to examine the social determinants of NCD multimorbidity in Jamaica, to better inform prevention and intervention strategies.MethodsLatent class analysis (LCA) was used to examine social determinants of identified multimorbidity patterns in a sample of 2551 respondents aged 15–74 years, from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008. Multimorbidity measurement was based on self-reported presence/absence of 11 chronic conditions. Selection of social determinants of health (SDH) was informed by the World Health Organization’s Commission on SDH framework. Multinomial logistic regression models were used to estimate the association between individual-level SDH and class membership.ResultsApproximately one-quarter of the sample (24.05%) were multimorbid. LCA revealed four distinct profiles: a Relatively Healthy class (52.70%), with a single or no morbidity; and three additional classes, characterized by varying degrees and patterns of multimorbidity, labelled Metabolic (30.88%), Vascular-Inflammatory (12.21%), and Respiratory (4.20%). Upon controlling for all SDH (Model 3), advancing age and recent healthcare visits remained significant predictors of all three multimorbidity patterns (p < 0.001). Private insurance coverage (relative risk ratio, RRR = 0.63; p < 0.01) and higher educational attainment (RRR = 0.73; p < 0.05) were associated with lower relative risk of belonging to the Metabolic class while being female was a significant independent predictor of Vascular-Inflammatory class membership (RRR = 2.54; p < 0.001). Material circumstances, namely housing conditions and features of the physical and neighbourhood environment, were not significant predictors of any multimorbidity class.ConclusionThis study provides a nuanced understanding of the social patterning of multimorbidity in Jamaica, identifying biological, health system, and structural determinants as key factors associated with specific multimorbidity profiles. Future research using longitudinal designs would aid understanding of disease trajectories and clarify the role of SDH in mitigating risk of accumulation of diseases.

The Lived Experience of Syrian Refugees in Canada: A Phenomenological Study

Health care providers in Canada are expected to take care of people from a variety of cultural backgrounds, and it is difficult for health care providers to deeply understand the lived experiences of some individuals to provide them with culturally sensitive care. Syrian refugees comprise one such group of newcomers to Canada. This phenomenological study aimed to uncover the meaning of the lived experiences of Syrian refugees using Giorgi’s (2009) method. Seven participants’ descriptions were viewed through the lens of the social determinants of health model. Seven essences of the general structural description or the meaning Syrian refugees gave to their experiences of living in Canada were synthesized. Syrian refugees live paradoxical experiences that are both rewarding and less rewarding when viewed through the lens of the social determinants of health (social support, environment, culture, education, health services, employment, and income). These experiences have influenced their health in both positive and negative ways. This study highlights the need for more culturally sensitive health care interventions and assistance for Syrian refugees/newcomers in Canada. As a next step, an action research study involving Syrian refugees as co-researchers may help address the social determinant of health risks in this population.

Examining Post-Migration Social Determinants as Predictors of Mental and Physical Health of Recent Syrian Refugees in Canada: Implications for Counselling, Practice, and Research

In response to the increasing number of Syrian refugees being resettled in Canada and worldwide, the present study set out to explore and examine critical post-migration predictors of mental health and physical health of adult Syrian refugees (n = 235) living in Windsor, Ontario. Using survey data collected from the national SyRIA-lth project and grounded in the Social Determinants of Health model, this study tested demographic, contextual, and psychosocial predictors in two regression models of mental health and physical health, respectively. The results showed that both predictive models were significant in explaining Syrian refugees’ mental and physical health outcomes, as hypothesized. Specifically, age, gender, satisfaction of health services, perceived control, and perceived stress predicted mental health in significant ways, whereas age, satisfaction of health services, and perceived stress predicted physical health in significant ways as well. Implications for practice and research with Syrian refugees, given the identified risk and protective factors of health, are considered.

Developing a Canadian framework for social determinants of health and well-being among children with neurodisabilities and their families: an ecosocial perspective

Purpose Social Determinants of Health is a conceptual framework typically used to understand patterns of health and ill-health at the population level. Its applicability to children and youth who already have a health condition, in this case, a neurodisability, is not well understood, particularly when the “health” component of that framework is extended to include more pluralistic notions of well-being. The purpose of this study was to address this challenge and to develop an ecosocial framework that is conceptually integrative and meaningful to children and youth with neurodisabilities and their families. Methods Drawing on a critical literature review, a conceptual analysis approach, and a secondary analysis of a compendium of 36 social determinants of health models, we critically analysed how these models map onto the context of childhood neurodisability and identified key conceptual and empirical challenges. The emerging framework was further validated through iterative stakeholder consultation with parents, self-advocates, researchers, practitioners, community leaders, and decision-makers. Results The review and consultation process generated The Canadian Framework for Social Determinants of Health and Well-being among Children with Neurodisabilities and their Families. This new framework consists of two hemispheres encompassing explanatory (or observational) and action-oriented (or transformational) components relating to social determinants of health and well-being and living a daily life of quality in childhood neurodisability. Conclusion The proposed framework provides a roadmap for practitioners, policy-makers, and researchers as well as activists, families, and communities, to reflect on both social determinants and social change processes that shape the health, well-being, and everyday lives of children and youth with neurodisabilities and their families. IMPLICATIONS FOR REHABILITATION Social Determinants of Health provides a conceptual framework for understanding the social causes and consequences of health and ill-health at the population level. In childhood neurodisability, however, it is important to consider pluralistic notions of “well-being” and living a daily “life of quality” that may relate, but are not limited, to health. The Canadian Framework for Social Determinants of Health and Well-being among Children with Neurodisabilities and their Families comprises an explanatory hemisphere of social determinants, factors, and contingencies, and an action-oriented hemisphere that identifies different forms and levels of mobilization that can guide rehabilitation practice to achieve social change in the lives of children, youth, and their families. Using an ecosocial perspective, this framework provides a roadmap for future research and policy development that is relevant to children and families as well as to current perspectives in rehabilitation, social and health justice, and childhood, disability, and neurodiversity rights.

Payment Structures That Support Social Care Integration With Clinical Care: Social Deprivation Indices and Novel Payment Models

The U.S. lags behind other developed countries in the use of indices and novel reimbursement models to adjust for social determinants of health (SDH) in medicine. This may be due in part to the inadequate body of research regarding outcomes after implementation of healthcare payments designed to address SDH. This perspective article focuses on four models employed both internationally and domestically to outline the implementation, successes, limitations, and research needed to support national application of SDH models. A brief history of prior models is introduced as a primer to the current U.S. system. Internationally, the United Kingdom and New Zealand employ small area indices to adjust healthcare dollar allocation based on increased social need in an area. Despite published evidence of disparate health outcomes based on SDH, research is limited on the association of SDH indices, subsequent increased reimbursement, and improved healthcare equity. In the U.S., the Massachusetts Managed Care Organization assesses and addresses social needs within communities served by Medicaid. Unsurprisingly, there is evidence of overlap between those with worse health outcomes and those with high social need. However, implementation in Massachusetts is too recent to demonstrate reduced healthcare disparities. Within Minnesota, Hennepin Healthcare System initiated a novel Medicaid waiver that provides extended services to high-need patients under a partial capitation reimbursement program. These services, including increased access to primary care, have promising results in financial improvement of the system, but have not yet demonstrated patient-oriented outcomes. The association between high social risk and poor medical outcomes has been established globally; however, healthcare payment policies designed to respond to this relationship generally lack evidence of affecting outcomes. U.S. policymakers are demonstrating increasing interest in requiring capture of SDH in health care, creating accountability for addressing SDH, paying differentially for patients with increased social risk, or all three. In countries with a legacy of adjusting healthcare payments for social risk, more robust evaluation of associated effects could be helpful. Payers, states, or health systems making similar resource commitments should build in robust longitudinal evaluations of outcomes to inform evolution of their payment policies. SUPPLEMENT INFORMATION: This article is part of a supplement entitled Identifying and Intervening on Social Needs in Clinical Settings: Evidence and Evidence Gaps, which is sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services, Kaiser Permanente, and the Robert Wood Johnson Foundation.