Meanings and Misunderstandings: A Social Determinants of Health Lexicon for Health Care Systems

Abstract

Health care systems and policymakers in the United States increasingly use language related to social determinants of health in their strategies to improve health and control costs, but the terms used are often misunderstood, conflated, and confused. Greater clarity on key terms and the concepts underlying them could advance policies and practices related to social determinants of health—including by defining appropriate roles and limits of the health care sector in this multisector field.

Emerging trends and challenges of population-based cardiology

“…Административно-бюджетное управление в США, например, обычно использует интервал времени длительностью пять лет или меньше для оценки эффектов проводимой политики [56], а этого бывает недостаточно. Более того, взаимопонимание между медиками и политиками, в целом, оставляет желать лучшего [58].…”

“…in the USA usually uses the time interval lasting for five years or less to assess the effects of the implemented politics [56], but it is sometimes not enough. Moreover, mutual understanding between medical specialists and politicians generally is far from perfect [58].…”

An evidence-based strategy to achieve equivalency and interoperability for social-behavioral determinants of health assessment, storage, exchange, and use

“…The three-tier scoring strategy permits SBDH data to (1) be used immediately at point of care (POC) by identifying social needs or social risk factors 3 and an actionable interpretation that links to patient goals and interventions, (2) be consumed within analytics and algorithms and for secondary analysis, and (3) produce a score that reflects total social determinant burden and behavioral burden across settings within a healthcare system. This strategy is an extension of the process reported by Wetta et al 27 The IOM published evidence-based recommendations suggesting SBDH that should be incorporated into the EHR 1 and, therefore, provided the foundation for the strategy to assess and store SBDH data for (1) diagnosis and treatment, (2) social needs and social risk factor referrals, (3) care coordination, (4) patient experience, (5) risk assessment, and (6) secondary uses for research.…”

“…1,2 Many factors, including genetics, lifestyle behaviors, environment, healthcare, and social determinants, influence population health. 3 According to Garg and Dworkin, 4 social and environmental factors likely have twice the impact on the overall health of an individual compared to quality health care. Deficits in education, housing, transportation, and income influence health behaviors, such as nutritional habits and physical exercise patterns, and are interwoven in the web of causation for disease.…”

“Super‐Utilizer” Interventions: What They Reveal About Evaluation Research, Wishful Thinking, and Health Equity

“…Red flags also have been waving for many years regarding the limits of trying to address the upstream, social drivers of health through individual‐level interventions aimed at complex patients . The majority of super‐utilizers live in communities facing multiple socioeconomic challenges.…”