Incorporation of Social Risk in US Preventive Services Task Force Recommendations and Identification of Key Challenges for Primary Care

Abstract

IMPORTANCEIn its mission to improve health, the US Preventive Services Task Force (USPSTF) recognizes the strong relationship between a person's health and social and economic circumstances as well as persistent inequities in health care delivery.OBJECTIVE To assess how social risks have been considered in USPSTF recommendation statements and identify current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations.EVIDENCE The USPSTF commissioned a technical brief that reviewed existing literature on screening and interventions for social risk factors and also audited the 85 USPSTF recommendation statements active as of December 2019 to determine how social risks were addressed in clinical preventive services recommendations.FINDINGS Among the 85 USPSTF recommendation statements reviewed, 14 were focused on preventive services that considered health-related social risks. Social risks were commonly referenced in parts of USPSTF recommendations, with 57 of 85 recommendations including some comment on social risks within the recommendation statement, although many comments were not separate prevention services. Social risks were commented on in USPSTF recommendations as part of risk assessment, as a marker of worse health outcomes from the condition of focus, as a consideration for clinicians when implementing the preventive service, and as a research need or gap on the topic.CONCLUSIONS AND RELEVANCE This report identified how social risks have been considered in the USPSTF recommendation statements. It serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated in USPSTF methods and recommendations.

Social Determinants of Cardiovascular Disease

“…These high-level health equity determinants influence the intermediary determinants, including social and community context (ie, food environment, social environment, and psychosocial factors), which ultimately define social risk through housing instability, food insecurity, financial strain, or limited transportation. 15 This framework disentangles structural health equity determinants into key constructs which allows a focus on their roles in the lived personal experiences of vulnerable populations, which may include implicit bias, everyday discrimination or stigma. This framework also allows for the exploration of the intersectional effects of broader sociopolitical, cultural and economic factors and intermediary health determinants on social position.…”

Provider–Patient Interactions as Predictors of Lifestyle Behaviors Related to the Prevention and Management of Diabetes

“…This combination-driven approach is not necessarily new to health services or public health, but it does require the re-imagining of how clinical care and population health practice fit together, recognizing that a combination of lifestyle changes alongside medical care tailored to the whole person and PSEs targeted at socioeconomic drivers of health inequities are all needed to optimize services for individuals with prediabetes and/or diabetes. Recent U.S. Prevention Services Task Force recommendations support this rationale [30]; they also highlight the importance of provider-patient interactions/communication alongside its previous recommendations on nutrition and physical activity [31] and intervening on social needs [32]. The pursuit of these lifestyle change strategies has global implications beyond what is taking place in the U.S. [33][34][35].…”

Social Determinants of Health, Race, and Diabetes Population Health Improvement: Black/African Americans as a Population Exemplar

“…In 2008, the World Health Organization (WHO) Commission on the Social Determinants of Health released a report introducing concepts and frameworks for understanding and mitigating the effects of SDOH [10]. The WHO set the stage for several subsequent US national committees and organizations to explore SDOH in the context of related phenomenon of racial and socioeconomic health disparities [11,12] and goals of achieving health equity [13]. Definitions of the key terms, including health disparities [11], health equity [13,14], and SDOH [15], are presented in Table 1.…”

“…US national committees and agencies have published recommendations for the health sector and health care organizations to address SDOH. These recommendations include National Academies of Sciences, Engineering, and Medicine (NASEM) reports on educating health care professionals to take action on SDOH [79], integrating social needs care into health care delivery [80], and addressing SDOH as a component of high-quality, patient-centered primary care [81], and United States Preventive Services Task Force (USP-STF) reports [12,38], among others. Several recommendations and resources address assessment and measurement of SDOH at both the individual patient level and community and population levels, as well as needs for data infrastructure for SDOH monitoring and evaluation [80,[82][83][84].…”