article - The NIC Collaboration Hub2024-03-29T13:30:16Zhttps://hub.nic-us.org/groups/social-determinants/resources/feed/tag/articleWhen Families Do Not Request Help: Assessing a Social Determinants of Health Screening Tool in Practicehttps://hub.nic-us.org/groups/social-determinants/resources/when-families-do-not-request-help-assessing-a-social-determinants2021-06-28T18:42:06.000Z2021-06-28T18:42:06.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Using pediatric social determinants of health screening data from a large medical system, we explored social needs dislosures and identified which needs were associated with resource connection requests. Method: Data came from records of outpatient pediatric patients (0–18 years) seen between October 2018 and March 2020 (39,251 encounters). We assessed percent of encounters where families (1) indicated a social need, and (2) requested a resource connection. We conducted multivariable logistic regression to identify which needs were associated with resource connection requests. Results: Among all encounters, 8% indicated a need and 2% requested a resource connection. Among families indicating a need, needs associated with resource requests included: housing (odds ratio [OR], 3.49 [2.42–5.03]), employment (OR, 3.15 [2.21–4.50]), food (OR, 1.89 [1.41–2.52]), and transportation (OR, 1.82 [1.30–2.56]). Discussion: Families seldom requested resource connections to address social needs. Better understanding families’ interests in receiving assistance is an important next step in pediatric social determinants of health screening system development.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0891524521000997?via%3Dihub=" target="_blank">Read the article >></a></p></div>Adjusting Quality Measures For Social Risk Factors Can Promote Equity In Health Carehttps://hub.nic-us.org/groups/social-determinants/resources/adjusting-quality-measures-for-social-risk-factors-can-promote-eq2021-04-20T18:40:49.000Z2021-04-20T18:40:49.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Risk adjustment of quality measures using clinical risk factors is widely accepted; risk adjustment using social risk factors remains controversial. We argue here that social risk adjustment is appropriate and necessary in defined circumstances and that social risk adjustment should be the default option when there are valid empirical arguments for and against adjustment for a given measure. Social risk adjustment is an important way to avoid exacerbating inequity in the health care system.</p>
<p><a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.01764" target="_blank">Read the article >></a></p></div>Determining the feasibility of an index of the social determinants of health using data from public sourceshttps://hub.nic-us.org/groups/social-determinants/resources/determining-the-feasibility-of-an-index-of-the-social-determinant2021-03-23T17:42:31.000Z2021-03-23T17:42:31.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Abstract:</p>
<p>Examining the feasibility of developing an index measure for the social determinants of health using public data is needed. We examined these characteristics at the ZIP code in California and New York using public data extracted from the US Census, American Community Survey, the USDA Food Research Access Atlas, and the Dartmouth Atlas. We conducted a retrospective study from 2000 to 2017. The main outcome was a novel index measure representing six domains (economic stability, neighborhood and physical environment, education, community and social context, food access, and health care) and encompassing 13 items. The index measure at the ZIP code was created using principal component analysis, normalized to “0” worse and “1” better in California (ZIP codes n = 1,447 to 1,515) and New York (ZIP codes n = 1,211 to 1,298). We assessed the reliability and conducted a nonparametric comparison to the Robert Wood Johnson Foundation County Health Rankings, Area Deprivation Index, Social Deprivation Index, and GINI Index. These measures shared similarities and differences with the novel measure. Mapping of this novel measure showed regional variation. As a result, developing a universal social determinants of health measure is feasible and more research is needed to link it to health outcomes.</p>
<p><a href="https://www.tandfonline.com/doi/full/10.1080/17538157.2021.1880413" target="_blank">Read the article >></a></p></div>One Year into the Pandemic: Implications of COVID-19 for Social Determinants of Healthhttps://hub.nic-us.org/groups/social-determinants/resources/one-year-into-the-pandemic-implications-of-covid-19-for-social-de2021-03-23T17:12:55.000Z2021-03-23T17:12:55.000ZHub Adminhttps://hub.nic-us.org/members/NIC<div><p>The Kaiser Family Foundation published an analysis of how COVID-19 has impacted the social determinants of health one year into the pandemic.</p>
<p><a href="https://www.kff.org/coronavirus-covid-19/issue-brief/one-year-into-the-pandemic-implications-of-covid-19-for-social-determinants-of-health/" target="_blank">Read the article >></a></p></div>A Social-Return-On-Investment Analysis Of Bon Secours Hospital’s ‘Housing For Health’ Affordable Housing Programhttps://hub.nic-us.org/groups/social-determinants/resources/a-social-return-on-investment-analysis-of-bon-secours-hospital-s-2021-03-23T14:15:25.000Z2021-03-23T14:15:25.000ZHub Adminhttps://hub.nic-us.org/members/NIC<div><p>Abstract:</p>
<p>Community health programs aimed at addressing the social determinants of health often face challenges demonstrating their impact through traditional economic evaluation methods of return-on-investment analysis, cost-effectiveness analysis, or cost-benefit analysis. Using a social-return-on-investment (SROI) analysis, we evaluated the broader social, environmental, and economic benefits of Bon Secours Hospital’s Housing for Health program, an affordable housing program aimed at addressing the social and environmental determinants affecting its community’s health in Baltimore, Maryland. Bon Secours currently has 801 units of affordable housing across twelve properties in West Baltimore. Results indicate the significant social value of the Bon Secours affordable housing program, generating between $1.30 and $1.92 of social return in the community for every dollar in yearly operating costs. These findings suggest that broader access to affordable housing could produce a positive social value and demonstrate the relevance of SROI for quantifying the impacts of community health programs.</p>
<p><a href="https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.00998?utm_medium=email&utm_source=hasu&utm_campaign=march2021issue&utm_content=drabo&utm_source=Newsletter&utm_medium=email&utm_content=Home-Based+Medical+Care%2C+Telehealth%2C+Housing+++More&utm_campaign=HASU%3A+3-21-21&vgo_ee=U4unNEAJkz6vbqAT07oZgOiIS83193%2B83Q2vWslix8I%3D" target="_blank">Read the article >></a></p></div>Home quality and child health: Analysis of the Survey of Income and Program Participationhttps://hub.nic-us.org/groups/social-determinants/resources/home-quality-and-child-health-analysis-of-the-survey-of-income-an2021-03-10T17:38:11.000Z2021-03-10T17:38:11.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Abstract:</p>
<p>Housing is considered a core social determinant of health (SDH) through mechanisms such as the quality, affordability, and location of the home. However, few nationally representative studies examine these mechanisms simultaneously with child health and healthcare use. To determine the associations between home quality and child health, a series of logistic regression analyses was employed using the Survey of Income and Program Participation (SIPP). The 2014 SIPP sample is a multistage, stratified sample of 53,070 housing units from 820 sample areas designed to represent the civilian, noninstitutionalized population of the United States. The analytic sample included 12,964 children aged 2–14 years. Poor housing quality was defined as whether the home had holes in the floor, cracks in the ceiling, plumbing issues, and/or pest problems. Outcome measures included child health status, number of medical visits, and hospitalizations. The results indicated that poor housing quality was associated with poorer health (OR = 1.16, 95% CI = 1.05–1.27) and a greater number of medical visits (OR = 1.11, 95% CI = 1.03, 1.20) after controlling for number of persons per household, neighborhood safety, nonmetropolitan status, parent’s ability to afford housing-related expenses, and other SDH. Future work investigating and intervening on the SDH in children could specifically include the quality and contexts in which homes are situated.</p>
<p><a href="https://journals.sagepub.com/doi/abs/10.1177/1367493520975956?journalCode=chca" target="_blank">Read the research article >></a></p></div>Implementing a Targeted Approach to Social Determinants of Health Interventionshttps://hub.nic-us.org/groups/social-determinants/resources/implementing-a-targeted-approach-to-social-determinants-of-health2020-12-21T18:07:12.000Z2020-12-21T18:07:12.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Abstract:</p>
<p>The scale of the coronavirus disease 2019 pandemic and its disproportionate impact on vulnerable populations has spurred unprecedented focus on and investment in social determinants of health (SDOH). Although the greater focus on social determinants is laudable and necessary, there is a tendency for health care organizations to implement SDOH programs at scale without rigorous evidence of effect, rather than targeting interventions to specific patients and assessing their impact. This broad, and sometimes blind, application of SDOH interventions can be costly and wasteful. We argue for rejecting the “more is better” mindset and specifically targeting patients who truly need and would substantially benefit from SDOH interventions. Matching interventions to the most appropriate patients involves screening for social needs, developing rigorous evidence of effect, and accompanying policy reform.</p>
<p><a href="https://www.ajmc.com/view/implementing-a-targeted-approach-to-social-determinants-of-health-interventions" target="_blank">Read the article >></a></p></div>What Is the Best Strategy for Social Determinants of Health Screens?https://hub.nic-us.org/groups/social-determinants/resources/what-is-the-best-strategy-for-social-determinants-of-health-scree2020-11-09T19:47:33.000Z2020-11-09T19:47:33.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Highlights:</p>
<ul>
<li>
<p>Relying simply on community-level data rather than conducting an individual social determinants of health screening increases the risk a patient will fall through the crack in social services interventions, according to new data published in JAMA Network Open. In other words, conducting a social determinants of health screening with individual patients provides more granular information about patient needs than looking at overarching risk factors in a certain geographic region.</p>
</li>
<li>
<p>Using census-tract level data, the researchers foremost worked to detect certain social risk factors based on community-level data. The researchers deemed a patient at-risk for social determinants of health if she lived in what the team determined to be an under-resourced neighborhood. Next, the team looked at individual-level social risk factor data gleaned from patient screenings. Those screenings asked patients about social challenges, like food insecurity, housing insecurity, and financial resource strain. The screenings provided individualized information about the social determinants of health.</p>
</li>
</ul>
<p><a href="https://patientengagementhit.com/news/what-is-the-best-strategy-for-social-determinants-of-health-screens?eid=CXTEL000000590793&elqCampaignId=16705&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=55ed680616a04359bacc4a50fac8afea&elq=687006bb99e549449ab5bc47ab69774f&elqaid=17497&elqat=1&elqCampaignId=16705" target="_blank">Read the article >></a></p></div>Docs Keep Focus on Social Determinants of Health, Eye Reimbursementhttps://hub.nic-us.org/groups/social-determinants/resources/docs-keep-focus-on-social-determinants-of-health-eye-reimbursemen2020-11-09T19:22:21.000Z2020-11-09T19:22:21.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Highlights:</p>
<ul>
<li>Nearly three-quarters of doctors agree that social determinants of health will put the biggest strain on the healthcare industry come 2021, according to the third part of The Physicians Foundation 2020 Survey of America’s Physicians. Another 44 percent said addressing health equity and inequity will be key for ensuring patient access to care, the survey showed.</li>
<li>Forty-percent of physician respondents agreed that socioeconomic issues—income, job security, educational attainment, and family support—are the most pressing social determinants of health. These factors influence other downstream social determinants of health. Addressing income inequality could help address housing security issues, for example.</li>
</ul>
<p><a href="" target="_blank">Read the article >></a></p></div>Top 5 Social Determinants of Health Domains for Payers to Addresshttps://hub.nic-us.org/groups/social-determinants/resources/top-5-social-determinants-of-health-domains-for-payers-to-address2020-11-03T17:11:03.000Z2020-11-03T17:11:03.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Highlights:</p>
<ul>
<li>There are five social determinants of health domains, according to the Office of Disease Prevention and Health Promotion (ODPHP) Healthy People 2030 website. While certain domains will at times require more urgent attention than others, a robust social determinants of health strategy may seek to address all five. The five social determinants of health domains encompass economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.</li>
<li>Social determinants of health strategies should first and foremost be anchored in the communities that the health plans are serving. However, payers can also evaluate their approach's comprehensiveness by assessing how they align with the five social determinants of health domains.</li>
</ul>
<p><a href="https://healthpayerintelligence.com/news/top-5-social-determinants-of-health-domains-for-payers-to-address?eid=CXTEL000000590793&elqCampaignId=16571&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=6b39469146ac4cf0a91c42562de65df1&elq=ec636b0e3d5f421188c163ffa941ec5f&elqaid=17352&elqat=1&elqCampaignId=16571" target="_blank">Read the article >></a></p></div>Why Teamwork Is Key to Addressing Social Determinants of Healthhttps://hub.nic-us.org/groups/social-determinants/resources/why-teamwork-is-key-to-addressing-social-determinants-of-health2020-09-14T15:24:41.000Z2020-09-14T15:24:41.000ZAmanda Taylorhttps://hub.nic-us.org/members/AmandaTaylor<div><p>Healthcare organizations setting out on a social determinants of health program must rely on community partners to effectively meet patient needs.</p>
<p><a href="https://patientengagementhit.com/news/why-teamwork-is-key-to-addressing-social-determinants-of-health?eid=CXTEL000000590793&elqCampaignId=15875&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=b15557aaa0584280a9f210719074eb4d&elq=b129fbb2c17f453bb7090e5c7030763a&elqaid=16644&elqat=1&elqCampaignId=15875" target="_blank">Read the article >></a></p></div>Health Care Spending And Use Among People Experiencing Unstable Housing In The Era Of Accountable Care Organizationshttps://hub.nic-us.org/groups/social-determinants/resources/health-care-spending-and-use-among-people-experiencing-unstable-h2020-03-02T17:21:36.000Z2020-03-02T17:21:36.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Abstract: Provider organizations are increasingly held accountable for health care spending in vulnerable populations. Longitudinal data on health care spending and use among people experiencing episodes of homelessness could inform the design of alternative payment models. We used Medicaid claims data to analyze spending and use among 402 people who were continuously enrolled in the Boston Health Care for the Homeless Program (BHCHP) from 2013 through 2015, compared to spending and use among 18,638 people who were continuously enrolled in Massachusetts Medicaid with no evidence of experiencing homelessness. The BHCHP population averaged $18,764 per person per year in spending—2.5 times more than spending among the comparison Medicaid population ($7,561). In unadjusted analyses this difference was explained by greater spending in the BHCHP population on outpatient care, including emergency department care, as well as on inpatient care and prescription drugs. After adjustment for covariates and multiple hypothesis testing, the difference was largely driven by outpatient spending. Differences were sensitive to adjustments for risk score, which suggests that housing instability and health risk are meaningfully correlated. This longitudinal analysis improves understanding of health care use and resource needs among people who are homeless or have unstable housing, and it could inform the design of alternative payment models for vulnerable populations.</p><p><a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.00687?utm_source=BHPN+Website+Newsletter+List&utm_campaign=e1d183b886-EMAIL_CAMPAIGN_2020_02_28_06_11&utm_medium=email&utm_term=0_c39fafc581-e1d183b886-340569897&" target="_blank">Read More >></a></p></div>Which Priorities for Health and Well‐Being Stand Out After Accounting for Tangled Threats and Costs? Simulating Potential Intervention Portfolios in Large Urban Countieshttps://hub.nic-us.org/groups/social-determinants/resources/which-priorities-for-health-and-well-being-stand-out-after-accoun2020-02-27T16:13:09.000Z2020-02-27T16:13:09.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p><strong>Context:</strong> Counties across the United States must contend with multiple, intertwined threats and costs that defy simple solutions. Decision makers face the necessary but difficult task of prioritizing those interventions with the greatest potential to produce equitable health and well‐being.</p><p><strong>Conclusions:</strong> To safeguard health and well‐being in a system dominated by tangled threats and costs, the most important priorities for a county cannot be simply inferred from a profile of its relative strengths and weaknesses. Two interventions stood out as the top priorities for almost all the counties in this study, and six others also were important contributors. Interventions directed toward these priority areas are likely to yield the greatest impact, irrespective of the county’s specifics. A significant concentration of resources in a regional portfolio therefore ought to go to these strongest contributors for equitable health and well‐being.</p><p><strong>Policy Points:</strong></p><ul class="unordered-list"><li>Interventions in a regional system with intertwined threats and costs should address those threats that have the strongest, quickest, and most pervasive cross‐impacts.</li><li>Instead of focusing on an individual county’s apparent shortcomings, a regional intervention portfolio can yield greater results when it is designed to counter those systemic threats, especially poverty and inadequate social support, that most undermine health and well‐being virtually everywhere.</li><li>Likewise, efforts to reduce smoking, addiction, and violent crime and to improve routine care, health insurance, and youth education are important for most counties to unlock both short‐ and long‐term potential.</li></ul><p><a href="https://www.milbank.org/quarterly/articles/which-priorities-for-health-and-well%E2%80%90being-stand-out-after-accounting-for-tangled-threats-and-costs-simulating-potential-intervention-portfolios-in-large-urban-counties/?utm_medium=email&utm_campaign=Regional%20Public%20Health%20Interventions%20Can%20Yield%20Greater%20Results%20When%20Designed%20to%20Counter%20Systemic%20Issues%20Like%20Poverty&utm_content=Regional%20Public%20Health%20Interventions%20Can%20Yield%20Greater%20Results%20When%20Designed%20to%20Counter%20Systemic%20Issues%20Like%20Poverty+CID_249768b6397ea9b2a2e3d5b721d20e58&utm_source=Email%20Campaign%20Monitor&utm_term=Read%20the%20article" target="_blank">Read More >></a></p></div>Social Determinants as a Preventive Service: U.S. Preventive Services Task Force Methods Considerations for Researchhttps://hub.nic-us.org/groups/social-determinants/resources/social-determinants-as-a-preventive-service-u-s-preventive-servic2019-12-11T16:05:17.000Z2019-12-11T16:05:17.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>The body of research on social determinants of health is rapidly accumulating. The U.S. Preventive Services Task Force is conducting evaluations to consider the inclusion of screening and counseling for social risks as a clinical preventive service. Yet, for many social risks, evidence is still likely needed before the U.S. Preventive Services Task Force can recommend universal screening or counseling. This manuscript offers a brief review of the social determinants of health that may be germane to the U.S. Preventive Services Task Force, the methods the U.S. Preventive Services Task Force uses to evaluate relevant evidence, and current evidence gaps for social risks. Key methods for making clinical preventive service recommendations are applied for considering the integration of social and clinical care. These methods include determining the certainty of the evidence, assessing the net benefit, defining appropriate prevention frameworks, defining health outcomes versus intermediate outcomes, fully assessing the harms, and defining to what populations and care contexts the evidence applies. This road map for research is intended to spark ingenuity and purpose in the next generation of research studies, thereby ensuring that future recommendations to address and prevent social risks in primary care are informed by high-quality evidence. <a href="https://www.ajpmonline.org/article/S0749-3797(19)30321-6/abstract" target="_blank">Read More >></a></p></div>A pilot food prescription program promotes produce intake and decreases food insecurityhttps://hub.nic-us.org/groups/social-determinants/resources/a-pilot-food-prescription-program-promotes-produce-intake-and-dec2019-12-11T15:46:30.000Z2019-12-11T15:46:30.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Food insecurity is associated with limited food resources that may lead to poor nutritional intake and diet-related chronic disease. Food prescription programs offer an avenue for facilitating access to fresh and healthy nonperishable food while reducing food insecurity. The purpose of this pilot study is to examine the feasibility, perceptions, and impact of a collaborative food prescription program in an area with a high rate of food insecurity. The study was a single group pre–post evaluation design. Participants were recruited from two school-based clinics and one Federally Qualified Health Center in north Pasadena, an area with a high rate of food insecurity in Harris County, TX. Adult, food insecure participants were screened at health clinics for eligibility. Participants received nutrition education materials and 30 pounds of a variety of fresh produce plus four healthy, nonperishable food items every 2 weeks for up to 12 visits at a local food pantry. Surveys and tracking tools monitored food insecurity, program dosage, reach, fidelity, acceptability, and program costs. Surveys and key informant interviews assessed perceptions of health care providers, implementation staff, and participants. Participants (n = 172) in the program reported a 94.1% decrease in the prevalence of food insecurity (p < .01) at the end of the program. An average of 29.2 pounds of fruits and vegetables were distributed per family per distribution, and 99% of participants reported eating “all” or “most” of the food provided. Program costs were $12.20 per participant per redemption. Interviews revealed that providers and participants felt the program was well received and highly needed. This pilot study demonstrates the framework and feasibility of a collaborative clinic-based food prescription program to address food insecurity. Future research should examine the sustained impact of such programs on behavioral and health outcomes. <a href="https://academic.oup.com/tbm/article-abstract/9/5/922/5579401?redirectedFrom=fulltext" target="_blank">Read More >></a></p></div>The feasibility of screening for social determinants of health: Seven lessons learnedhttps://hub.nic-us.org/groups/social-determinants/resources/the-feasibility-of-screening-for-social-determinants-of-health-se2019-12-11T15:40:37.000Z2019-12-11T15:40:37.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>"Social determinants of health” (SDOH) has become an inescapable buzzword in family medicine in part because of the magnitude of impact that SDOH have on our patients' wellbeing. Drawing a direct comparison between social factors and medical conditions, researchers have estimated that low education, racial segregation, and low social support make a contribution to mortality that is equivalent to acute myocardial infarction, cerebrovascular disease, and lung cancer, respectively. Particularly as we strive toward the Quadruple Aim in health care, the “conditions in which people are born, grow, live, work, and age” can no longer be categorized strictly as nonmedical factors and, therefore, outside the scope of primary care</p><p>Although many in primary care agree about the importance of screening patients for social needs and referring to supportive community resources, legitimate concerns exist about the feasibility of doing so. To explore these issues, our family medicine clinic recently conducted a nine-month SDOH pilot project. This article shares our outcomes and some surprising lessons learned. <a href="http://https//www.aafp.org/fpm/2019/0900/p13.html" target="_blank">Read More >></a></p></div>For An Option To Address Social Determinants Of Health, Look To Medicaidhttps://hub.nic-us.org/groups/social-determinants/resources/for-an-option-to-address-social-determinants-of-health-look-to-me2019-12-11T15:28:50.000Z2019-12-11T15:28:50.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Research affirms what we intuitively know: The ability of individuals and families to lead healthy and productive lives is influenced by a multitude of factors. Beyond the more commonly recognized factors such as insurance coverage and access to medical care are the non-medical social determinants of health (SDOH). These non-medical drivers include access to healthier foods, safer neighborhoods, reliable transportation, and educational attainment. They also include how we behave in our environment such as <a href="https://www.healthaffairs.org/do/10.1377/hblog20190115.234942/full/" target="_blank">exercise, eating habits, and tobacco use</a>. SDOH account for more <a href="https://www.cdc.gov/socialdeterminants/index.htm" target="_blank">health outcomes</a>, including cost, than medical care alone. Importantly, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28688725" target="_blank">emerging evidence</a> suggests that addressing negative SDOH can lead to improvements in health outcomes... <a href="https://www.healthaffairs.org/do/10.1377/hblog20190701.764626/full/" target="_blank">Read More >></a></p></div>Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal studyhttps://hub.nic-us.org/groups/social-determinants/resources/effect-of-provincial-spending-on-social-services-and-health-care-2019-12-09T19:39:44.000Z2019-12-09T19:39:44.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Escalating health care spending is a concern in Western countries, given the lack of evidence of a direct connection between spending and improvements in health. We aimed to determine the association between spending on health care and social programs and health outcomes in Canada. We used retrospective data from Canadian provincial expenditure reports, for the period 1981 to 2011, to model the effects of social and health spending (as a ratio, social/health) on potentially avoidable mortality, infant mortality and life expectancy. We used linear regressions, accounting for provincial fixed effects and time, and controlling for confounding variables at the provincial level. <a href="https://www.cmaj.ca/content/190/3/E66" target="_blank">Read More >></a></p></div>Social Determinants As Public Goods: A New Approach To Financing Key Investments In Healthy Communitieshttps://hub.nic-us.org/groups/social-determinants/resources/social-determinants-as-public-goods-a-new-approach-to-financing-k2019-12-09T19:35:32.000Z2019-12-09T19:35:32.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Good research evidence exists to suggest that social determinants of health, including access to housing, nutrition, and transportation, can influence health outcomes and health care use for vulnerable populations. Yet adequate, sustainable financing for interventions that improve social determinants of health has eluded most if not all US communities. This article argues that underinvestment in social determinants of health stems from the fact that such investments are in effect public goods, and thus benefits cannot be efficiently limited to those who pay for them—which makes it more difficult to capture return on investment. Drawing on lesser-known economic models and available data, we show how a properly governed, collaborative approach to financing could enable self-interested health stakeholders to earn a financial return on and sustain their social determinants investments. <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.0039" target="_blank">Read More >></a></p></div>Redistributing Investment in Health and Social Services—The Evolving Role of Managed Carehttps://hub.nic-us.org/groups/social-determinants/resources/redistributing-investment-in-health-and-social-services-the-evolv2019-12-09T19:31:59.000Z2019-12-09T19:31:59.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><div class="widget-ArticleFulltext widget-instance-AMA_Article_Abstract_Widget"><div class="article-full-text"><p class="para">The national dialogue on how best to promote health in the United States, and doing so as efficiently as possible, is changing. The United States spends more on health care than other high-income countries but achieves similar or worse outcomes on key health indicators.<sup><a class="ref-link section-jump-link" href="https://jamanetwork.com/journals/jama/article-abstract/2712365#jvp180126r1">1</a></sup> While increased access to high-quality, cost-effective care may be a necessary condition for resolving this paradox, it is clearly not sufficient. Indeed, a wide range of social, economic, and environmental factors may exert a more powerful influence on health and health outcomes. <a href="https://jamanetwork.com/journals/jama/article-abstract/2712365" target="_blank">Read More >></a></p></div></div></div>The Impact of Racism on Child and Adolescent Healthhttps://hub.nic-us.org/groups/social-determinants/resources/the-impact-of-racism-on-child-and-adolescent-health2019-12-09T18:47:12.000Z2019-12-09T18:47:12.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Abstract: The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families. <a href="https://pediatrics.aappublications.org/content/144/2/e20191765" target="_blank">Read More >></a></p></div>Change and stability in offender, behaviours, and incident‐level characteristics of mass public shootings in the United States, 1984–2015https://hub.nic-us.org/groups/social-determinants/resources/change-and-stability-in-offender-behaviours-and-incident-level-ch2019-12-09T18:38:38.000Z2019-12-09T18:38:38.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>For the last 40 years, the general profile of mass public shooters has enjoyed enduring consensus by experts, and as a result, it has remained static over this time. However, a recent string of mass public shootings perpetrated by “atypical” offenders bring into question the stability of the characteristics, motivations, and methods employed by these offenders. The goal of this study is to examine the stability and change of these characteristics and behaviors over the last 32 years (1984–2015). Using an open‐source database, this study compares mass public shootings in 2000–2015 time period to the attacks committed in 1984–1999. The results illustrate not only sharp increase in number of mass public shootings in the last 16 years but also a significant growth in the racial heterogeneity and background characteristics of these offenders, clearly marking a departure from the general accepted profile of mass public shooters and mass murderers. The results also point to key characteristics, and behaviors that have remained static during the analysis time. Additionally, this study explores the implications these changes and stability on crime prevention strategies, as well as strategies to mitigate the lethality of these attacks. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jip.1491" target="_blank">Read More >></a></p></div>Leveraging the Social Determinants of Health: What Works?https://hub.nic-us.org/groups/social-determinants/resources/leveraging-the-social-determinants-of-health-what-works2019-12-09T18:33:17.000Z2019-12-09T18:33:17.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Abstract: We summarized the recently published, peer-reviewed literature that examined the impact of investments in social services or investments in integrated models of health care and social services on health outcomes and health care spending. Of 39 articles that met criteria for inclusion in the review, 32 (82%) reported some significant positive effects on either health outcomes (N = 20), health care costs (N = 5), or both (N = 7). Of the remaining 7 (18%) studies, 3 had non-significant results, 2 had mixed results, and 2 had negative results in which the interventions were associated with poorer health outcomes. Our analysis of the literature indicates that several interventions in the areas of housing, income support, nutrition support, and care coordination and community outreach have had positive impact in terms of health improvements or health care spending reductions. These interventions may be of interest to health care policymakers and practitioners seeking to leverage social services to improve health or reduce costs. Further testing of models that achieve better outcomes at less cost is needed. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988629/" target="_blank">Read More >></a></p></div>Social Capital: Measurement and Consequenceshttps://hub.nic-us.org/groups/social-determinants/resources/social-capital-measurement-and-consequences2019-12-09T18:29:07.000Z2019-12-09T18:29:07.000ZNavah Steinhttps://hub.nic-us.org/members/NavahStein<div><p>Abstract: A number of indicators suggest that there has been a sharp decline in social capital in the United States since the mid-1960s. After rising for most of the first two thirds of<br />the 19TH century, formal membership and participation in civic organizations, levels of trust, and charitable giving have all seen sharp declines. There is a strong relationship, across American states, between measures of social capital and educational performance, health, tax evasion and self-assessed welfare. Although this pattern still needs far more detailed analysis, it is pronounced enough to justify further attention to social capital and its potentially powerful implications for a range of public policy issues. <a href="https://smg.media.mit.edu/library/putnam.pdf" target="_blank">Read More >></a></p></div>