In 2020, U.S. life expectancy fell to its lowest level since 2003, ranking 26th out of 35 OECD nations despite having advanced medical technology and spending more on healthcare than any other country. Traditional medical care isn’t enough to improve those sobering statistics. Public health experts are now focusing on the role of the social determinants of health, factors related to where Americans live, work, and spend their leisure time. Factors including employment status, education, income, housing, food security, transportation, and the environment can have a major impact on health outcomes. Federal agencies responsible for these and other aspects of American life have the opportunity and responsibility to integrate the SDOH into their missions and their work.
The Department of Health and Human Services has made improving the SDOH a high priority. HHS has integrated the SDOH into Healthy People 2030, an ambitious program that sets data-driven national objectives for health and well-being. HHS brought in outside experts to help develop Healthy People 2030, and has engaged federal agencies through the Social Determinants of Health Workgroup.
Last September, HHS and the nonprofit Center for Open Data Enterprise co-hosted a roundtable building on this work by bringing together experts from different sectors for discussions on improving the SDOH. This Roundtable on Cross-Sectoral Collaboration on the Social Determinants of Health showed how interrelated the different aspects of the SDOH are.
The roundtable also identified cases that demonstrate how SDOH factors in different sectors can affect health and well-being, and how federal agencies could address them. For example, recent work by the Federal Transit Administration demonstrated the importance of transportation to healthcare access, and health and well-being. The Department of Transportation could apply these learnings to improve transportation options in the interest of health. The agency could support programs to connect communities that are far from healthcare facilities with reliable and affordable transportation, or to develop infrastructure like sidewalks and bike paths that make it easier for people to exercise.
Transportation options can be closely tied with the location and quality of people’s housing. Substandard housing, often compounded by environmental factors, negatively impacts health and well-being. According to a 2017 assessment by the Government Accountability Office, 15% of rental units have issues including rodent infestations, water leaks, and defective heating that combine with environmental factors like cold weather or low air quality to hinder health. The Department of Housing and Urban Development could set SDOH-driven targets around lead abatement, indoor air quality, air conditioning for residences with extreme heat risk, and other factors. It is vital to proactively address these issues, many of which are being compounded by climate change.
In fact, climate change acts as a threat multiplier across the SDOH. The National Oceanic and Atmospheric Administration, the Federal Emergency Management Agency, and the White House Office of Science and Technology Policy are already exploring ways to expand and improve climate information and services for the public around hazards like fire, flooding, and drought. They can look at these issues through an SDOH lens and develop specific objectives and targets to address the impacts of climate hazards on health and the SDOH.
CODE’s report on the roundtable includes a number of action opportunities for federal agencies to improve SDOH conditions for all Americans. CODE is also publishing a cross-sector SDOH data hub that shows the wealth of data on SDOH factors that already exists, and makes it easily accessible for analysis. CODE’s report highlights opportunities to make progress by adapting and applying Healthy People 2030 to the state and local level; coordinating work on the SDOH within and between federal agencies more effectively; setting targets for progress in underrepresented areas, using an equity lens; and making SDOH data easier to access and use.
CODE is also continuing its work on SDOH with a focus on its application to racial equity. On April 6, CODE co-hosted a webinar to explore that topic and other applications of open government data for racial equity in healthcare, and featured speakers from government and the private sector.
Ultimately, agencies across the federal government share responsibility for protecting Americans’ health and well-being in the face of the COVID-19 pandemic, climate change, racial injustice, and economic inequity. The SDOH provide a framework to meet that challenge, building on the strong foundation that HHS has established. Federal agencies have an opportunity to work together, to collaborate with coalitions of stakeholders outside of government, and to set ambitious goals for improving Americans’ health and set about achieving them.
Joel Gurin is president of the Center for Open Data Enterprise (CODE), where Matthew Rumsey is research and communications manager.