Over the past two years, the impact of social determinants of health (SDoH) on wellbeing has become a higher priority issue nationwide. The pandemic clearly shed light on the fact that SDoH disproportionately affect low-income and BIPOC communities. The reality has become hard to ignore.
Although COVID-19 elevated the visibility of these issues, SDoH are not a new phenomenon. Nearly 20 years ago, a from the Institute of Medicine found that members of minority groups are less likely than white individuals to receive preventative care. In addition, of the minority group members who do receive preventative care, it is often lower quality and leads to worse outcomes for many conditions. Factors such as housing inequality, systemic racism and other socioeconomic inequities have reinforced this reality.
The time has come to build a more equitable public health system to address these issues and others by prioritizing three key areas: infrastructure, integration and investment.
Infrastructure: Level the Technology Playing Field
Access to broadband internet service has become a necessity for millions of Americans to access and manage their healthcare — whether through telehealth services, remote monitoring of health conditions or simply logging into a provider's online portal to check lab results or to send a clinician a message.
Unfortunately, when it comes to the infrastructure needed to support broadband internet access, we are a country of "haves" and "have nots." Among those living in , for example, only 43% of low-income adults can access the internet.
The good news is the federal government is taking several steps to bolster the technology infrastructure for all Americans. In October 2022, the U.S. Department of Agriculture announced that it is providing $759 million to bring high-speed internet access to individuals in 24 states, Puerto Rico, Guam and Palau. This includes funding from President Biden's Bipartisan Infrastructure Law, which provides $65 billion to expand access to reliable and affordable high-speed internet to all American communities. This legislation also reduces the costs associated with internet service, so more people can utilize the internet.
Integration: Data Access is Essential to Whole Person Healthcare
The healthcare sector knows what is necessary to advance whole person care — we must overcome barriers to data sharing and cross-sector collaboration, engage consumers in their health and wellbeing, and advocate for policies that support the viability of integrated care models.
Plans are being developed and progress is being made in several areas to integrate information systems, with the goal of improving health outcomes for Americans of all ages. Some examples include:
- Improving immunization record tracking. All states currently operate immunization information systems (IISs) to track vaccination information. While these systems historically have focused on children's immunization data, work is underway to expand their use to adult vaccine information. This would be valuable in the event of another pandemic as well as for closing gaps in seasonal flu vaccinations or pneumonia vaccinations for the elderly. The federal government's Healthy People 2030 plan includes an objective related to increasing the number of people represented in these systems.
- Reducing food insecurity. Given high rates of inflation, many more low-income families are now dealing with the very real problem of food insecurity. Information system integration could play an important role in addressing this issue. For instance, states could use data from their systems to determine whether women qualify for the federal government's Special Supplemental Nutrition Program for Women, Infants and Children (WIC). If a woman is already receiving Medicaid or participating in the Supplemental Nutrition Assistance Program (SNAP), she already meets the income eligibility requirements for WIC. In addition, if a woman gives birth, Medicaid claims data could be used to automatically trigger a benefits evaluation to ensure that the family receives WIC benefits for the additional child.
- Addressing SDoH. Better integration between information systems at the federal, state and local levels are needed to combat SDoH issues like housing insecurity, social isolation, financial stresses and more. Medical, social service and public health systems need to work together. For example, data sharing between state agencies and community resources like public housing authorities, councils on aging and other agencies would make it easier to provide care and resources to people across all stages of life.
Investment: Dedicate Resources Over the Long Term
As we consider strategies for improving the public health system, there is no doubt that long-term investments will be needed. Lessons learned from prior public health emergencies can inform how we develop robust investment plans.
The H1N1 epidemic, for example, spurred funding and investment initiatives. But they were unfortunately short-lived, and funding dried up when the crisis was no longer top of mind. Looking forward, we must not lose sight of the benefits of a stronger and more equitable public health system. Long-term and sustained investment is essential for providing better care to all Americans, as well as building resilience into the system so we will be prepared for large scale crises in the future, such as the next pandemic that may come along.