The Latest

The February issue of Health Affairs featured many SDOH-related papers. Below we highlighted several of these that present evidence on the effectiveness of policies aimed at addressing health-related social needs and/or structural-level drivers of health. Read on for excerpts, and follow the links for the full read.

We’ve talked about racism as a driver of health in previous posts; indeed, the toll of racism on BIPOC (Black, Indigenous, People of Color) bodies has gained increasing national attention in recent weeks, especially in light of the coronavirus, which exacts disproportionate economic and health tolls on racial minorities and immigrants, and police killings of

Continue Reading “SDOH Roundup: Racism as a Driver of Health”

The measures taken in the United States in an effort to slow the spread of coronavirus have dire economic consequences, the worst the country has seen since the Great Depression. Unemployment has skyrocketed, and many Americans find themselves unable to provide for their basic needs. However, this hardship has affected the U.S. population differently and

Continue Reading “The Economic Costs of COVID-19”

What determines health? That question drives all our work, and while we’ve observed a lot of progress in untangling the many answers to that question, we have very few tools for measuring different health effects.

At an April 11 press conference, Surgeon General Jerome Adams acknowledged that people of color are disproportionately affected by COVID-19. For example, African Americans comprise 25% of the population of Milwaukee County, Wisconsin but nearly half of confirmed cases and three-quarters of the deaths. Latinos represent one-third of the population of New York City but

Continue Reading “Social determinants, racism, and COVID-19”

Co-authored by Austin Frakt and Kate Raphael The most recent issue of Health Affairs focuses on “Integrating Social Services & Health,” and many of the articles highlight the ways in which social policy is linked to health outcomes. Here are a few that stood out to us.   Linking Health And Social Services Through Area

Continue Reading “Integrating Social Services & Health”

This post, by Austin Frakt, originally appeared on The Incidental Economist on April 2, 2020. I don’t have time for a fully formed post or column on this, but I want to make note of a few ways in which the COVID-19 pandemic is intersecting with drivers of health (which include social determinants and health system

Continue Reading “Drivers of Health and the Coronavirus”

We understand that social policies have great potential to affect health, but studies that aim to document the associations between policy interventions and health outcomes are often methodologically weak.

We’ve done several roundups of SDOH in the news. Here’s another collection of excerpts from six stories that caught our eye.

Social determinants of health and health-related social needs are frequently featured in both popular news sources and academic publications. These excerpts from six recent stories caught our eye.

The response to drug epidemics cuts along lines of race and class. In my recent piece with Toni Monkovic in the New York Times’ Upshot Dr. M. Norman Oliver, Virginia’s health commissioner, said, “At the beginning, the opioid epidemic was centered in rural Appalachia, and as long as it involved poor rural whites, it did

Continue Reading “Racial bias in medicine”

This post, by Carmen Mitchell, originally appeared on The Incidental Economist. Carmen Mitchell is currently a fourth-year health policy doctoral student in the Department of Health Management and Systems Sciences at the University of Louisville School of Public Health and Information Sciences (SPHIS). She is currently affiliated with The Afya Project, an interdisciplinary research initiative

Continue Reading “Let’s Retire Myths About Individual Behavior and Health”

Social determinants of health comes up from time to time in health policy news, reports, and scholarly articles. Here are quotes from five of these that caught my eye recently.

This post, by William Gardner, originally appeared on The Incidental Economist. Dr. Gardner is a psychologist. He is the Senior Research Chair in Child and Adolescent Psychiatry at the Children’s Hospital of Eastern Ontario Research Institute, and Professor of Epidemiology at the University of Ottawa. He tweets at @Bill_Gardner.

The U.S. Department of Agriculture is considering cutting food stamps for 700,000 Americans, and while this change would supposedly save money in the short run, it could have untold costs in the long run. Research has shown that programs like SNAP and WIC are associated with better health and reduced spending on avoidable hospitalizations. Furthermore,

Continue Reading “The Price of Food Insecurity”

The following is an interview with Patrick Scott Romano, MD, MPH, FACP, FAAP, Professor of Internal Medicine and Pediatrics at UC Davis Health and C0-Editor in Chief of Health Services Research.

The following is an interview with Lisa Simpson, MB, BCh, MPH, FAAP, President and CEO of AcademyHealth, with input from several senior staff at AcademyHealth. Follow her on Twitter @DrSimpsonHSR

This is a guest post by Bechara Choucair, MD, the Senior Vice President and Chief Community Health Officer at Kaiser Foundation Health Plan, Inc. and Hospitals. He spoke on one of our panels in Cambridge and reflects on the meeting in this blog. 

It is well documented that housing is closely associated with health. The location, condition, and context of where we live intersect many factors that indirectly affect health. Our housing literally encompass environmental (think: dust and exposure to the elements) and social factors (think: isolation and crime) that directly affect health. A person experiencing homelessness would

Continue Reading “Housing and Health: What Does the Literature Tell Us?”

Across many disciplines, greater educational attainment is closely associated with health. People who have obtained more schooling are significantly likelier to live longer, healthier lives. The mediating pathways that facilitate this connection are myriad and complex. A number of pathways have been proposed, including ones involving health literacy and behaviors, employment opportunities, and social and

Continue Reading “Education and Health: What Does the Literature Tell Us?”

In an illuminating set of conversations on Monday at the Drivers of Health event in Cambridge, a diverse group of experts discussed how health care providers, local policy makers and community groups can work together to provide everyone in society with “a fair and just opportunity to live their healthiest life possible,” as Julie Morita,

Continue Reading “Getting under the hood of social determinants: Thoughts from the Cambridge meeting”

The following is an interview with Kathy Ko Chin, MS, President and CEO of the Asian & Pacific Islander American Health Forum, a national health justice organization which influences policy, mobilizes communities, and strengthens programs and organizations to improve the health of Asian Americans, Native Hawaiians, and Pacific Islanders. She’ll be speaking as a panelist

Continue Reading “Addressing Symptoms and Root Causes”

This post, by Harold Pollack, was originally published on September 22, 2012 on The Incidental Economist. It is reposted with permission here. Dr. Pollack is the Helen Ross Professor of Social Service Administration at the University of Chicago. Over the past decade, he has conducted diverse studies and intervention trials to improve services to vulnerable

Continue Reading “Moving to Opportunity”

The following is an interview with Betsey Tilson, MD, MPH, Director and Chief Medical Officer for the North Carolina Department of Health and Human Services. She’ll be speaking as a panelist at our Cambridge meeting on December 2.

It seems intuitive that providing people with accurate health information will help them make better health decisions. But just providing information backed by research isn’t enough to change minds, let alone behavior.

The following is an interview with Daniel Polsky, PhD, MPP, Distinguished Professor of Health Economics at the Bloomberg School of Public Health at Johns Hopkins University.

The following is an interview with Sandro Galea, PhD, physician, epidemiologist, author, and dean and Robert A. Knox Professor at Boston University School of Public Health.

The community of scholars (including some of us on this project) and the health care industry have been using “social determinants of health” to mean so many things that it has lost its original meaning. Sometimes precise definitions don’t matter too much if everyone knows what is meant from context. But I don’t think that’s

Continue Reading “We have a terminology problem”

Considering how much money we spend on health care in the U.S., we might hope that we allocate a good chunk of it toward evaluating the impact of the health policies we have in place. Unfortunately, this is rarely the case.

In other blog posts, we’ve discussed U.S. health care spending and outcomes. In short, we spend a lot more on medical care than other high-income countries, yet our health outcomes are often worse. We also spend a lot of money on social programs, which have been shown to be associated with improved health outcomes. It

Continue Reading “The Price of Social Programs”

Social determinants of health comes up from time to time in health policy news or as the subject of reports from health policy-focused organizations. Here are quotes from four stories or reports that caught my eye recently.

The Drivers of Health meeting in Detroit on September 11 focused on the research and research gaps in the connection between health and housing (presented by Roshanak Mehdipanah of the University of Michigan) and education (presented by Adriana Lleras-Muney of UCLA). The meeting wrapped up with a panel discussion including those two scholars and Robert

Continue Reading “Debriefing on Detroit”

In one of his recent Health Care Triage videos, Aaron Carroll calls attention to a recent study published in the Journal of the American Heart Association that supposedly tells us something new about plant-based diets and health.

As I read more of the social determinants of health-related literature, I’m noticing a frequent theme: we don’t have enough information to guide decision making.

The Urban Institute recently published a report titled “What Would it Take to Reduce Inequities in Healthy Life Expectancy?” Its purpose is to articulate strategies to boost the effectiveness of the health system in addressing health-related social needs to narrow health inequities and areas of research that would help it do so. But it also

Continue Reading “From the Urban Institute: What Would it Take to Reduce Inequities in Healthy Life Expectancy?”

The following is an interview with Len M. Nichols, Ph.D., Director, Center for Health Policy Research and Ethics, Professor of Health Policy, College of Health and Human Services, George Mason University.

One of the goals of Drivers of Health project is to engage diverse audiences in learning about what affects our health. But how do you get people interested? We thought an interactive might help, so we made one.

African American men live about 4.6 fewer years than non-Hispanic white men. There are many causes contributing to the difference, including a learned mistrust of the health system by African Americans. Another set of potential factors arises when non-black physicians treat black men. According to a study published earlier this year, that care just isn’t

Continue Reading “When black patients see non-black doctors”

Factors that affect health are often described as either “proximal” (downstream or directly affecting health) or “distal” (upstream or indirectly affecting health). For example, income is thought of as distal (upstream) because it doesn’t directly affect health.

In the United States, African American men have the worst health outcomes of any major demographic group. At age 45, their life expectancy is more than three years less than that of non-Hispanic Caucasian men and more than five years less than African American women.

While there is widespread understanding that the health system and other factors — social determinants — affect health, we know relatively little about their precise contributions to health differences across a population at a point in time or differences in health of a fixed population over time.

A common way to assess how much various factors contribute to health is to estimate how much variation in health across the country is explained by each of those factors. But explaining variation is not as useful as many may think.

I wrote about Nancy Krieger’s insightful American Journal of Public Health paper in a previous post. In this second of three posts, I will continue to unpack some of the content of her article, focusing on the distinction between correlation and causation.

In 2017, Nancy Krieger, Professor of Social Epidemiology at the Harvard T.H. Chan School of Public Health, published a truly insightful paper in the American Journal of Public Health in which she raised several conceptual problems with allocating health outcomes to contributions from risk factors.

The next public meeting of the Drivers of Health project will be held in Detroit on September 11. Housing, education, and access and quality of health care will be the focus. Why? This post explains.

In late June, Public Agenda published a report on perspectives of low-income parents on pediatric screening for social determinants of health. A key conclusion suggests a substantial challenge.

Social determinants of health comes up frequently in health policy news. Here are quotes from six stories that caught my eye over the last few months.

There’s a lot of evidence that social determinants of health are especially important in the early years of life. Experiences, resources, and opportunities available during childhood can influence health in ways that persist through adulthood. For these reasons, it’s especially important to evaluate the effectiveness of Early Childhood Programs, those interventions targeted at children, usually

Continue Reading “Do Early Childhood Programs Work?”

Housing significantly affects health. In our homes, we experience the intersection of many health-related factors, and when we spend so much time in this environment, the cumulative effects of where we live can have long-term health consequences.

The following is an interview with Paula M. Lantz, PhD, Associate Dean for Academic Affairs, James B. Hudak Professor of Health Policy, Ford School of Public Policy, University of Michigan. Dr. Lantz is also a member of the Drivers of Health project advisory committee.

For low-income renters and residents in the U.S., access to affordable housing has strong ties to health care spending. People faced with high rent and housing costs often forego preventive care in an effort to lessen their already significant financial burdens.

The second in a series of posts providing insights from our advisory committee members, the following is a brief interview with Heather Howard, J.D., Lecturer in Public Affairs at the Woodrow Wilson School of Public and International Affairs, Princeton University.

Health Services Research (HSR) and the Robert Wood Johnson Foundation (RWJF) are partnering to publish a 2020 Theme Issue on Drivers of Health, to be co-edited by me and David Nerenz, PhD.

This is a guest post by Lynn Todman, PhD, the executive director for population health at Spectrum Health Lakeland in St. Joseph, Michigan, where she also serves on the City Commission. She is a Robert Wood Johnson Foundation Culture of Health Leadership Fellow. 

Education is strongly associated with health outcomes, but the pathways between them are less clear. Though there’s a lot we don’t know about the relationship, careful study has teased out some explanations.

The following is a brief interview with David R. Nerenz, Ph.D., Director Emeritus, Center for Health Policy and Health Services Research, Vice-Chair for Research, Department of Neurosurgery, Henry Ford Health System. Dr. Nerenz serves on the Drivers of Health advisory committee.

In the 1980s through the mid-1990s there was little the health system could do to address AIDS. Today there is a lot. Would we therefore attribute no deaths to AIDS in the 1980s and early 1990s to access to health care and some of them to that factor today?

An interesting tension was raised several times at the first Drivers of Health meeting in Princeton. (You can watch the webcast of the meeting here.) On the one hand, there’s a temptation — even a policy need — to separate social determinants and health care.

Education is related to health. Better educated people tend to be healthier. Why? The pathways from education to health are varied and complex, as explained by Paula Braveman, one of the speakers at our Princeton meeting.

Much of what I’ve learned about the effect of health care on longevity comes from the work of David Cutler. He’s one of our speakers at the Princeton meeting. This post a preview of some of what he might say.

Here’s a puzzle: To what would you attribute deaths from AIDS today? Genetics? Behavior? Social or environmental factors? The health system (or its failure)? Something else? Once you have your answer, how would you know it was right? How would you test it? What evidence would you need? What studies would you do?

For centuries privileged classes have placed people into racial categories and acted upon them in ways that reflect and cement power. Racial discrimination has been woven into the fabric of many, if not all, U.S. institutions. The health system is not immune.

How much value do we obtain per dollar spent on the health system? How has that changed over time? How does it compare across countries? These are tough but important questions.

The risks to health faced by Americans long ago are different from those we face today. Some of the things that once killed many people (like poor sanitation) now kill many fewer. On the other hand, we now face new risks (like death from auto accidents) that didn’t exist a century ago.

The causal pathways from social determinants of health to health outcomes can be numerous and complex. Though some factors (like smoking) are directly related to health, others (like education or income) relate to health in a variety of indirect ways.

The U.S. is the biggest spender on health care in the world, yet national health outcomes do not reflect this massive investment. This fact forces us to question the value of health care spending: are our health care dollars worth it?

What drives health? This is the big and challenging question my team and I are facing on a new, one – year project funded by the Robert Wood Johnson Foundation. This website is devoted to this question, and we invite you to engage with us as we explore it.