By Luke Testa, Program Assistant, The Harvard Global Health Institute In 2018, a short video circulated on WhatsApp claiming that the MMR vaccine was designed by Indian Prime Minister Narendra Modi to stop the population growth of Muslims. Subsequently, hundreds of madrassas across western Uttar Pradesh refused to allow health departments to vaccinate their constituents.
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Unemployment Insurance Can Help Reduce Food Insecurity, the More Generous the Better
March 26, 2021
By Luke Testa
By Cecille Joan Avila, policy analyst at Boston University School of Public Health. She tweets at @cecilleavila. Since the start of the COVID-19 pandemic in March 2020, more than 54 million Americans have lost jobs. Because of this loss in wages, two times as many Americans became susceptible to food insecurity, defined by the US

Texans’ Public Opinions on Social Determinants of Health
January 15, 2021
By Luke Testa
A first-ever Texas public opinion survey on social determinants of health (SDOH) has revealed that Texans largely agree on many issues regarding the significance of the impact of non-medical factors on human health. Recognizing the increasing awareness that social factors impact people’s well-being, the Episcopal Health Foundation (EHF) surveyed a representative sample of 1,200 adults
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We know paid family leave saves infant lives — so when will policymakers catch up?
December 16, 2020
By Luke Testa
This post originally appeared on The Center for Health Journalism here. By Diana Montoya-Williams December 14, 2020 During a pandemic that has overwhelmed many intensive care units, those that serve our youngest infants have so far been spared from a surge of COVID-19 patients. This is in part due to the apparent low risk of mother-to-baby transmission of

Permanent Supportive Housing: An Effective Intervention for Chronically Homeless People
November 30, 2020
By Luke Testa
Homelessness is associated with high utilization of acute health care services. Among those who are homeless, a small proportion of individuals make up a large percentage of service use and likely face the most significant barriers to securing housing. For homelessness assistance services, engagement and retention in housing are critical priorities. New research from UC

A Survey of Racial and Ethnic Disparities in COVID-19 Outcomes at State, Tribal, and County Levels
November 13, 2020
By Luke Testa
This post originally appeared on The Incidental Economist here. Allison R. Kolbe, Ph.D. is an Oak Ridge Institute for Science and Engineering Fellow at the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Sean A. Klein, Ph.D. is a Presidential Management Fellow at the U.S. Department of

Moving Towards Equity: New Knowledge on Drivers of Health Webinar Series
November 9, 2020
By Luke Testa
On October 21st and 28th, authors from six articles featured in the Drivers of Health Health Services Research theme issue participated in a two-part webinar series to share key insights from their research. Authors discussed the significance of their findings as well as implications for social/health care system interventions. Key themes in the webinars included
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How leading programs to address SDoH are pivoting in response to COVID – and what they’ve learned
October 17, 2020
By Luke Testa
By Alexandra Schweitzer The COVID pandemic changed the landscape of the social needs that drive health overnight. Millions of people lost their jobs; millions of people were ordered to stay home. People lost access to food for themselves and their families because they couldn’t afford it, or they couldn’t get to a grocery store. Miles

Want to Prevent Suicides? Understand Its Causes
September 28, 2020
By Luke Testa
By Farrokh Alemi, Professor of Informatics, George Mason University Suicide prevention is getting a bad rap. Many are frustrated by its lack of effectiveness. It seems effective in some countries and for males, but in the United States, flagship programs such as the Veteran Affairs Suicide Prevention program have been accompanied with increased suicides and
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Released: Health Services Research (HSR) 2020 Theme Issue on Drivers of Health
September 28, 2020
By Luke Testa
The Health Services Research (HSR) 2020 Theme Issue on Drivers of Health has been released! This open-access issue includes fourteen cutting-edge, peer-reviewed articles that illuminate social determinants of health and social/health care system interventions that promote wellbeing.

Confronting Structural Racism
August 14, 2020
By Austin Frakt
Earlier this month, I participated in a plenary panel on confronting structural racism in health services research at the AcademyHealth Annual Research Meeting. I believe most of what I said generalizes outside of this field of research. My opening comments are below, and I was joined on the panel by Don Taylor and Sherilynn Black (Professor

SDOH Research in Health Affairs
July 1, 2020
By Kate Raphael
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.

SDOH Roundup: Racism as a Driver of Health
June 17, 2020
By Kate Raphael
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
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The Economic Costs of COVID-19
May 6, 2020
By Kate Raphael
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

“Addressing Social Determinants of Health: Time for a Polysocial Risk Score”
April 22, 2020
By Kate Raphael
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.

Social determinants, racism, and COVID-19
April 16, 2020
By Austin Frakt
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”

Integrating Social Services & Health
April 9, 2020
By Kate Raphael
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

Drivers of Health and the Coronavirus
April 2, 2020
By Kate Raphael
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

“Social Policy is Health Policy”: A Review of the Evidence
March 31, 2020
By Kate Raphael
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.

Social Determinants of Health in the News
February 19, 2020
By Kate Raphael
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 in the News
February 12, 2020
By Kate Raphael
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.

Racial bias in medicine
February 5, 2020
By Austin Frakt
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

Let’s Retire Myths About Individual Behavior and Health
January 29, 2020
By Kate Raphael
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
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Social determinants of health in the news
January 22, 2020
By Austin Frakt
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.

Healthy behavior matters. So are we responsible if we get sick?
January 15, 2020
By Austin Frakt
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 Price of Food Insecurity
January 8, 2020
By Kate Raphael
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,

The Shifting Boundaries of Health Care
December 24, 2019
By Kate Raphael
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.

Accelerating progress rests on effective health care leadership
December 19, 2019
By Kate Raphael
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

Driving Health Forward Across Communities
December 17, 2019
By Kate Raphael
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.

Housing and Health: What Does the Literature Tell Us?
December 12, 2019
By Kate Raphael
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
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Education and Health: What Does the Literature Tell Us?
December 10, 2019
By Kate Raphael
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?”

Getting under the hood of social determinants: Thoughts from the Cambridge meeting
December 5, 2019
By Austin Frakt
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,

Addressing Symptoms and Root Causes
November 26, 2019
By Kate Raphael
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

Moving to Opportunity
November 22, 2019
By Kate Raphael
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

Addressing SDOH in North Carolina
November 19, 2019
By Kate Raphael
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.

Why aren’t facts enough?
November 14, 2019
By Luke Testa
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 Value of our Health Care Dollars
November 7, 2019
By Kate Raphael
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.

Health as the means, not the end
November 4, 2019
By Kate Raphael
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.

We have a terminology problem
October 28, 2019
By Austin Frakt
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

Which Health Policies Work?
October 22, 2019
By Kate Raphael
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.

The Price of Social Programs
October 16, 2019
By Kate Raphael
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

Social determinants of health in the news
October 7, 2019
By Austin Frakt
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.

Debriefing on Detroit
October 3, 2019
By Austin Frakt
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

Plant-Based Diets and Mortality
October 1, 2019
By Kate Raphael
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.

Addressing social needs requires good evidence
September 25, 2019
By Austin Frakt
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.

From the Urban Institute: What Would it Take to Reduce Inequities in Healthy Life Expectancy?
September 23, 2019
By Austin Frakt
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

Rethinking Regulations: Smarter Investments in Social Needs
September 19, 2019
By Austin Frakt
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.

Connecting the Dots
September 17, 2019
By Austin Frakt
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.

When black patients see non-black doctors
September 9, 2019
By Austin Frakt
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”

The Proximal/Distal Paradigm
September 4, 2019
By Austin Frakt
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.

The legacy of the Tuskegee study
August 28, 2019
By Austin Frakt
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.

What is known about drivers of health: a literature review
August 26, 2019
By Austin Frakt
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.

Allocating health outcomes to risk factors, part 3
August 21, 2019
By Austin Frakt
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.

Allocating health outcomes to risk factors, part 2
August 19, 2019
By Austin Frakt
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.

Allocating health outcomes to risk factors, part 1
August 14, 2019
By Austin Frakt
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.

Next Phase for the Drivers of Health Project
August 12, 2019
By Austin Frakt
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.

Pediatric social determinants screening
August 5, 2019
By Austin Frakt
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 in the news
July 31, 2019
By Austin Frakt
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.

Do Early Childhood Programs Work?
July 29, 2019
By Kate Raphael
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

Doorway to Health: Investigating the Housing Effect
July 24, 2019
By Kate Raphael
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.

When and how do we intervene to address health-related social needs?
July 22, 2019
By Austin Frakt
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.

Does high rent affect health care spending and outcomes?
July 17, 2019
By Austin Frakt
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.

Improving health with limited means: addressing housing and education
July 15, 2019
By Austin Frakt
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.

Call for Papers for Health Services Research (HSR) Theme Issue: Drivers of Health
July 11, 2019
By Austin Frakt
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.

Big Data Has Potential to Drive Big Decisions
July 10, 2019
By Austin Frakt
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.

Untangling the Pathways Between Education and Health
July 8, 2019
By Austin Frakt
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.

Why Social Isolation, Poverty & Low Health Literacy Matter
July 1, 2019
By Austin Frakt
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.

What Causes AIDS Deaths? (Part 2)
June 27, 2019
By Austin Frakt
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?

Social determinants and/or health care?
June 18, 2019
By Austin Frakt
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 and Health: The work of Paula Braveman
June 15, 2019
By Austin Frakt
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.

Health care and longevity: the work of David Cutler
June 14, 2019
By Austin Frakt
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.

What Causes AIDS Deaths?
June 13, 2019
By Austin Frakt
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?

Racial identity and the health system
June 11, 2019
By Austin Frakt
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.

Health system cost-effectiveness
June 1, 2019
By Austin Frakt
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.

Social determinants over time
May 12, 2019
By Austin Frakt
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.

Social determinant pathways are complex
April 30, 2019
By Austin Frakt
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 value of health spending
April 30, 2019
By Austin Frakt
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?
April 1, 2019
By Austin Frakt
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.