Explore the U.S. Playbook to Address Social Determinants of Health (SDoH)

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Individual health is influenced by a variety of non-medical factors, like where people are born, live, learn, work, play, worship, and age.  

These conditions are known as Social Determinants of Health (SDoH). 

To help improve health and wellbeing through SDoH, the White House and U.S. Department of Health and Human Services (HHS) have released new resources, including the first-ever U.S. Playbook to Address Social Determinants of Health. 

“It is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food, and clean air to breathe,” said HHS Secretary Xavier Becerra. “It is crucial for HHS to tackle health care and public health holistically by addressing patients’ social conditions.”  

Let’s dive into what these resources entail and how they could improve SDoH.  

U.S. Playbook to Address Social Determinants of Health  

The Biden-Harris Administration released the U.S. Playbook to Address Social Determinants of Health in November 2023. 

The playbook highlights the need for well-coordinated systems of health and social care to better address social needs that can impact health, and how the federal government is taking action to achieve this transformation.  

“Our vision is to enable every American to lead a full and healthy life within their community,” according to the playbook.  

The playbook focuses on three pillars of interventions with actions:  

Playbook Pillar 1: Expand Data Gathering and Sharing 

This pillar aims to capture basic information on social circumstances and environmental exposures that impact health to improve data gathering and interoperability to address SDOH.  

“Recognizing the foundational role of data to support future innovation, the Administration will expand the collection of SDOH data for health research,” according to the playbook.  

Playbook Pillar 2: Support Flexible Funding to address Social Needs 

Another goal is to increase funding flexibility and offer technical assistance that empowers organizations to use funding from a variety of sources to better equip them to address unmet social needs.  

“The Administration continues to work across the federal government to identify new avenues for using federal dollars to improve the social circumstances and health outcomes for all Americans,” according to the playbook.  

Playbook Pillar 3: Support Backbone Organizations 

These are backbone organizations: 

• Community-based organizations 
• health care providers and related support services 
• state, local territorial, and tribal governments 
• public health authorities 
• health plans  

“[These organizations] all have a role to play in building and sustaining the infrastructure needed to support such a system,” according to the playbook. 

The Biden-Harris Administration is working to provide backbone organizations with educational assistance, technical resources, data security training, and support in payment operations.  

More details and the complete outlined playbook of actions and initiatives can be found here.  

“Achieving this vision will require bold collaboration as well as a shared agreement that significant and sustainable change must take place in order to effectively address the underlying drivers of suboptimal health outcomes in our society,” the playbook states.  

Call to Action to Address Health Related Social Needs 

HHS also released a Call to Action to Address Health Related Social Needs. 

This call encourages partnerships between individuals working in health care, social services, public and environmental health, government, and health information technology to address health-related social needs.

Like the playbook, it emphasizes backbone organizations and their important role in managing community-based partnerships across various sectors.

“[Backbone organizations] can help develop and sustain community-based infrastructure and partnerships to improve coordination between health care and community-based organizations (CBOs) to address an individual’s HRSNs and are important partners for health care in meeting these needs,” according to HHS.

Recommended resources include:  

• Community-Based Organizations 
• Health Systems/Clinicians 
• Payers 
• Public Health Departments 
• Health Information Technology Community  

For the complete call to action, go here. 

Medicaid and CHIP Health-Related Social Needs Framework 

Unmet health-related social needs (HRSN) can contribute to worse health outcomes and health inequities. This is especially true for children and adults at risk for poor health outcomes, and individuals in historically underserved communities. 

So, the Centers for Medicare & Medicaid Services (CMS) created the Medicaid and CHIP Health-Related Social Needs Framework. 

The framework provides guidance for more states, beyond the current seven, to structure programs that address housing and nutritional insecurity for enrollees in high-need populations. 

The framework  lists HRSN services and support that is considered allowable under specific Medicaid and Children’s Health Insurance Program (CHIP) authorities and provides a discussion of the relevant considerations for each authority.  

“[We support] states in addressing HRSN through coverage of clinically appropriate and evidence-based HRSN interventions, care delivery transformations including improvements in data sharing, and performance measurement to create accountability for HRSN screening and connecting to needed supports as part of successful care management,” according to the CMS.  

To explore the full framework, go here.  

How Can Your Healthcare System Address SDoH Issues? 

Your healthcare system can implement SDoH screening. 

More healthcare systems, hospitals, and clinics are screening patients for SDoH through written questionnaires or verbal questions. Screenings can cover a variety of SDoH topics, such as mental and financial health and access to healthy food, transportation, and housing. 

For example, Nemours Children’s Health implemented SDoH screening. 

About 35% of Nemours patients who screen positive for at least one social need say they want a referral to community resources. 

In addition, the National Association of Community Health Centers also is helping community health centers (also called Federally Qualified Health Centers) conduct SDoH screening to identify social needs in patients and refer them to local aid and resources. 

“SDoH screening has the power to address a variety of health-related social needs for Latinos and all people,” said Dr. Amelie Ramirez, director of Salud America! and its home base, the Institute for Health Promotion Research at UT Health San Antonio. 

Get help exploring SDoH screening and find SDoH screening tools here or here. 

How Can You Shape Local SDoH Issues? 

Download Salud America’s Health Equity Report Card. 

The report card provides maps, data, and gauges to compare social determinants of health and public health issues to the rest of your state and nation 

You can email your report card to local leaders to stimulate community change. 

You can also use the data in your materials or share on social media to raise awareness about local SDoH issues that need to be addressed. 

GET YOUR HEALTH EQUITY REPORT CARD!