Addressing Social Determinants to Improve Health Outcomes

Panel Composition and Core Premise

• The session features a panel of experts from academia, public service, and the private sector to discuss social determinants of health (SDOH).
• Panelists include:
  • Dr. Karen DeSalvo: Former Acting Assistant Secretary of Health; Professor at University of Texas.
  • Esther Dyson: Executive Founder of Wellville.
  • Sergio Matos: Executive Director of the Community Health Worker Network of New York City.
  • Alan Moses: Independent healthcare consultant; former CMO of Novo Nordisk.
• The central premise is that factors beyond medical care and genetics—specifically where people live, learn, work, and play—are the primary drivers of human health outcomes.

Evidence and Efficacy of SDOH Interventions

• Scope of Impact: Medical care accounts for only 10–20% of health outcomes; the majority is determined by social and environmental factors.
• Humana Case Study:
  • Addressing social isolation and food insecurity has generated a calculated return of approximately $15 per member per month.
  • Interventions resulted in improved self-reported "healthy days" and increased community engagement among members.
• Community Health Worker (CHW) Data:
  • Analysis of the Centers for Medicare & Medicaid Services (CMS) Innovation Center's $10 billion award pool found CHWs were the only funded intervention to significantly lower costs across the board in their first year.
  • Evidence supports CHWs as a "peer model" where community members share lived experiences with those they serve, fostering empowerment rather than dependency.
• Cities Changing Diabetes Program:
  • A public-private partnership focused on urban environments to address Type 2 diabetes and obesity (attributable risk of 44%).
  • In Houston, a coalition involving the mayor, public health department, and academic institutions utilized religious communities to deliver preventive care, demedicalizing obesity and diabetes into social support programs.
• Wellville Pilot Projects:
  • Selected five specific communities (Spartanburg, SC; North Hartford, CT; Muskegon, MI; Lake County, CA; Clatsop County, OR) to focus on density and penetration rather than scale.
  • Programs aim to build self-sustaining "fishing institutions" rather than providing temporary aid or standard clinical interventions.

Barriers to Mainstreaming SDOH

• Funding Structure: Most SDOH initiatives rely on one-off grants, philanthropy, or special CEO projects rather than being integrated into the "usual course of business."
• Actuarial Hesitancy: CMS actuaries require high-confidence data and accurate projections for the Medicare trust fund, creating a bottleneck for adopting new SDOH models like CHWs.
• The "RCT Culture" Trap:
  • Esther Dyson argues that the strict requirement for Randomized Controlled Trials (RCTs) prevents the iterative learning and adaptation necessary for start-up-style innovation.
  • Communities are often "addicted" to short-term pilot programs rather than long-term institutional planning.
• Systemic Distrust and Power Dynamics:
  • Sergio Matos identifies a fundamental lack of trust in the healthcare system among marginalized communities due to historical inequities and power imbalances.
  • The current system is criticized for medicalizing social issues rather than addressing root causes, often enforcing power over communities rather than sharing it.
• Fragmentation and Silos: Short-term funding cycles and disconnected sectors (schools, housing, justice) hinder the development of holistic, long-term solutions.
• Institutional Language Barriers: Alan Moses notes that the division between "medical" and "social" spheres is artificial; the challenge is integrating health into daily life and systemic design rather than treating it as a clinical issue.

Strategic Directions and Future Actions

• Policy and Reimbursement:
  • States like New York, Oregon, Minnesota, Massachusetts, and North Carolina are beginning to integrate SDOH into Medicaid programs, though coverage remains population-specific.
  • Bipartisan momentum is building to pass legislation allowing healthcare dollars to fund food access and social impact partnerships.
• Community Ownership Models:
  • The Robert Wood Johnson "Culture of Health Prize" and the Beaumont Foundation's BUILD program are cited as successful models for generating evidence and sustaining community-led initiatives.
  • The goal is to shift from "doing for" communities to "partnering with" communities to ensure interventions are culturally relevant and sustainable.
• Advocacy and Education:
  • Panelists urge the CDC to update the Diabetes Prevention Program with modern nutritional science rather than focusing solely on low-fat/calorie counting.
  • Call to action for actuaries and HHS to recognize SDOH as critical to economic vitality and to move beyond viewing them as "nice-to-do" community benefit activities.
• Addressing Social Isolation:
  • Sergio Matos highlights that the healthcare system's tendency to separate patients by condition exacerbates social isolation, a primary driver of poor health.
  • Success requires breaking down silos and fostering connection rather than isolation.
• Local-to-National Impact:
  • Helen (final panelist) suggests that breaking local barriers and removing politics to focus on citizen health in specific communities is the most viable path to national and global improvement.