Social drivers of health matter. How can hospitals help?

It is largely accepted that social factors such as income, education, and zip code impact our health and well-being. As hospitals are increasingly addressing these drivers of health for the communities they serve, a new report shows where hospitals could focus their efforts next. 

Report highlights community priorities

Earlier this year, The Root Cause Coalition – a nonprofit coalition of nearly 100 health systems and insurers, community-based organizations, and policy centers  – released a report on community attitudes and opinions on the social drivers of health, access to healthcare, and exactly whose responsibility it is to ensure that this care is provided. 

The report used data from a nationally representative sample of 1,000 survey responses and 32 conversations with Medicare and Medicaid enrollees, leaders of social service organizations, and primary care providers, to shed light on some of the biggest social issues facing Americans. Respondents put housing (55%) and food security (49%) at the top of the list when it comes to priority areas for policymakers. 

“Lack of access in one area affects so many other parts of your life … how it’s all intertwined and not really recognized. It’s thought of separately and not as a whole.” 

Focus group participant, Assessing Social Drivers of Health

Another top issue was healthcare access, with respondents citing barriers such as geography, transportation, and mistrust in medical institutions. Compounded by the fact that patients aren’t always sure where to go for help, respondents were often left feeling “embarrassed” and “frustrated” about asking for help and determining where to go for their health-related needs. When it came to the role of medical institutions in addressing these needs, only 27% of respondents felt that healthcare providers were “very trustworthy” sources of information.

The role of hospitals

Are hospitals responsible for solving all of the problems identified within The Root Cause Coalition’s report and beyond? No, but they do have a role to play, especially when it comes to access to care. 

A 2023 Lown Institute report found that 77% of hospitals fail to follow through on expected charity care and community investment, leading to $14.2 billion in unrealized community benefit.  The need for increased spending and regulations surrounding community investment is gaining recognition on a national scale, drawing the attention of policymakers such as Senator Bernie Sanders (D-VT) and other members of the Senate Health, Education, Labor, and Pensions (HELP) Committee. 

For health systems and hospitals that have the financial resources to invest, there is a real possibility to reduce these numbers and make progress towards mitigating the impact of social drivers on the communities they serve.

Here are some other ways hospitals can improve access to care, housing, or food security: 

• Advance affordable housing: Accelerating Investments for Healthy Communities – an initiative taken on by six leading hospitals and health systems to advance affordable housing policies and funding with local partners – resulted in a $5 million grant to address social drivers in low-income communities, the construction of 40 rental and homeownership units in a neighborhood near a hospital, and much more. Other initiatives such as NYC Housing for Health have made long-term pledges to help bring people closer to care by building nearly 650 new affordable homes on hospital land over the next five years.
• Prescribing nutritious meals: Predominantly serving immigrant, food-insecure cancer patients, NYC created their FOOD – “Food to Overcome Outcome Disparities” – program, bringing medically-tailored meals to the hospital room. Through a combination of stakeholder collaboration, patient risk assessment, and patient education, the initiative is responsible for providing more than 300,000 meals to patients since 2011. With an eye towards nutrition-related illness and under-nutrition for our low-income patients, Boston Medical Center’s Preventive Food Pantry has distributed more than 1 million pounds of food throughout the Greater Boston Area.
• Meet people where they are: Hospitals are reimaging how they provide care beyond hospital walls. Denver Health has brought healthcare to students, providing essential health services such as immunizations and birth control while providers in Boston have hit the road, providing healthcare services to the unhoused population throughout the City. Chicago Mount Sinai Hospital has worked to meet people where they are financially as opposed to physically, using a third-party system to predict financial need and automatically approve patients for financial assistance, ensuring they get the care they need at an affordable price.
• Advocate for systemic change: Housing and food security are huge problems that hospitals can’t solve on their own. But they can be forces for systemic change by pushing for policies on a state and national level that will make a difference in the lives of their patients. For example, Governor Gavin Newsom (D-CA) recently approved an extensive housing package aimed at simplifying and expediting the construction of new, affordable housing and protecting tenants. Senate Bill S.855 – recently referred to the Committee on Housing in Massachusetts – aims to create a flexible housing pool to help vulnerable populations secure stable housing. Hospitals should leverage such legislative action to get involved in helping their communities overcome barriers to health.

Hospitals are just one piece of the puzzle when it comes to advancing health equity. A portion of the community has spoken to their biggest priorities, and it’s time we respond.