A Standardized Approach is Needed to Address Social Determinants of Health

by Colleen Bridger, PhD, MPH


Colleen Bridger social determinants of health

The Big Cities Health Coalition (BCHC) is a forum for the leaders of America’s largest metropolitan health departments to exchange strategies and jointly address issues to promote and protect the health and safety of the 55 million people they serve. Together, these public health officials directly affect the health and well-being of one in six Americans. The BCHC is a project of the National Association of County and City Health Officials (NACCHO). NACCHO represents the nation’s 2,800 local governmental health departments. These city, county, metropolitan, district, and tribal departments work every day to protect and promote health and well being for all people in their communities. For more information about NACCHO, please visit www.naccho.org. Posts in this series are published with permission from BCHC and originally appeared on the Front Lines Blog. Please visit Big Cities Health Coalition and the Front Lines Blog for more information about the work they’re doing to improve population health.

America leads the world in medical research and medical care, and for all we spend on health care, we should be the healthiest people on earth. Yet on some of the most important indicators, like how long we live, we’re not even in the top 25, behind countries like Bosnia and Jordan. There is growing recognition that health starts – long before illness – in our homes, schools and jobs. In fact, only about 20 percent of a person’s health happens in the doctor’s office – the rest happens out in the world and things like healthy air and water may not be in a person’s control.

Addressing these “social determinants of health” is not only important for fostering a healthier population, but also for reducing health disparities that are often rooted in social and economic disadvantages.

The challenge is, how do we – health departments, community organizations, doctors, clinicians, and health companies – collectively work to address these issues outside our walls and think more systemically about potential solutions?

This was the topic of conversation at a recent symposium hosted by the San Antonio Health Advisory Board that brought together nearly 140 of San Antonio’s leaders from more than 70 nonprofits, health systems, technology solutions, and health benefits providers. Each with a stake in the game, we talked at length about understanding these issues, taking action in the clinical setting, and looked at what other communities are doing for best practices to set the course for San Antonio’s future.

Many groups are already asking the people they serve questions about some of the four core social determinants of health areas: 1) housing/utilities; 2) food insecurity; 3) transportation and 4) interpersonal safety. These domains are priority because of clear evidence that they are associated with a host of negative health outcomes.

What we didn’t realize is how vastly the screenings differ from one another. It turns out that screenings for things that keep us healthy in our communities, schools and workplaces are disparate, so much so that the data cannot be captured and evaluated in a meaningful way.

This poses a barrier for us to look at community health issues from a systemic perspective, as we do not have data that we can aggregate to assess a complete picture of our community’s health status and risks associated with social and environmental factors. This data is necessary to improve our ability to understand the “upstream” factors affecting our community’s health. It could also inform the provision and funding of community resources by providing data showing the need for such services.

What we can learn from a standardized approach to addressing social determinants of health in every person in our city ranges from how to help individuals in need when we see them, to uncovering population health issues that may be solved more efficiently and effectively.

The first step to getting there is tangible and actionable. We need a standardized set of questions – one simple screening – around each of the four core social factors that hold people back from being healthy. That will help maintain strong citywide focus on social determinants of health and allow for uniform collection of data on unmet needs.

Beyond just the screening tool, the creation of a shared platform for accessing the data once collected is also essential to solving this problem. The screening tool takes care of step one, but that data needs to go somewhere, so a central tech solution is necessary to aggregate and access the information.

All Americans should have the opportunity to make the choices that allow them to live a long, healthy life regardless of their income, education or ethnic background. We need to stop thinking of health as something we get in hospitals and doctors’ offices, but instead as something that starts in our families, in our schools and workplaces, on our playgrounds and parks, and in the air we breathe and the water we drink. Standardizing how we ask those questions will help us better understand the challenges our community faces and help us focus our work on addressing those challenges. What we can learn from a standardized approach to addressing social determinants of health in every person in our city ranges from how to help individuals in need when we see them, to uncovering population health issues that may be solved more efficiently and effectively.


Colleen Bridger, PhD, MPH

Colleen Bridger, PhD, MPH, was named director of the San Antonio Metropolitan Health District in March 2017. Dr. Bridger is responsible for implementing policies aimed at improving the health of the population in San Antonio and Bexar County and managing nearly two dozen programs, including WIC, vector control, air quality, STD/HIV prevention and Tuberculosis control and prevention. She has oversight of a $44,000,000 budget and a staff of nearly 400 public health professionals.

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