Making Societal Factors Part of a Health Equity Strategy

By The SHSMD Team posted 08-18-2021 09:33 AM

Social determinants of health is a topic that is finally getting its due in health care – it is the subject of an upcoming session at SHSMD Connections, virtual event, this October. In a recent episode of SHSMD’s Rapid Insights podcast co-presenters of this breakout session covering this topic, Julia Resnick, senior program manager of strategic initiatives at the American Hospital Association and Ji Im, system senior director of community population health at Common Spirit Health come together to discuss the importance of understanding social needs of a community and then understand the systemic causes.

The COVID-19 pandemic has placed the spotlight on health inequities in the U.S. One pathway for improving health equity is to address the societal factors that influence health. These factors are the nonmedical ones that influence whether we stay healthy or become ill.

One of the silver linings of this pandemic has been that as a society, we're really understanding and recognizing how societal factors lead to health inequities more than ever before. “I can't tell you how excited I was to hear people talking about social determinants of health on cable news. That's very different than what we've been seeing before,” states Resnick.

It is imperative to understand that only about 20% of our health comes from the medical care we receive and jarringly, the other 80% is attributable to the societal factors. That's where and how we live our day-to-day lives - things like: if our air is not clean, if our home is not safe, our food isn't nutritious, if our job doesn't cover our bills, or our children - don't receive a quality education then health inevitably suffers.

Improving health equity
To think about improving health equity, it is not just about providing more equitable health care but it's about how we can address the nonmedical factors in our society that contribute to the inequities. Hospitals serving as anchors in their communities with missions that are explicitly tied to improving health and wellbeing for the communities, they serve have a really important role to play in this space.

80% of your health comes from outside of the health care you receive. So, how can a hospital or health system diagnose the societal health of their individual community? And how do they assess their own community to determine those health inequities?

There are two complimentary ways that hospitals can approach understanding the societal factors that impact their patients in the communities they serve: at the patient level screening for social needs and at the broader community level screening for community health needs.

Plan of action
Once a hospital or health system understands the issues, how they go about addressing the societal factors that influence health in their community is really the crux of the issue. It is complex and challenging and it's outside the scope of traditional medical practice.

Resnick emphasizes that healthcare organizations and hospitals can really make an impact in this space.

“At the AHA, we're trying to create resources that help hospitals to understand like what steps they can take to make progress on that journey. We developed a practical framework that sets forth three distinct yet connected levels that show how hospitals can address patients' social needs, social determinants of health in the community, and the systemic causes of those health inequities,” states Resnick.Image ID is: courtesy of the American Hospital Association (

Access to coverage
Access to coverage, navigation, benefit programs, has always been a top issue at CommonSpirit Health. Behavioral health is another top need including mental health and substance use disorders. And then we see obesity, chronic diseases, violence and safety, as well as other social determinants of health as top rising needs.

Ji Im shares more on CommonSpirit Health and the issues they are seeing. Their hospitals conduct community health needs assessments, by looking at secondary data that's publicly available for other communities to use and do local serving, interviewing focus groups, town halls. All these efforts are made on a three-year basis to identify the needs of the communities. And through this process, the top needs don't really change too much.

Im shares, “We don't really see these needs changing year to year. The other reality is that all these societal factors are so closely interconnected. A person is never having a health coverage issue or an unstable housing issue alone. If these individuals are struggling with one, then the chances that they're struggling with another part of their life, is pretty likely.”

The Connected Community Network
Common Spirit Health has deployed a strategic effort to address these factors found in the communities that they serve. They call it the Connected Community Network or CCN. The CCN model is a multi-stakeholder initiative. It was formed to address the social needs of individuals living in a community. It is a network of community organizations on one technology platform, to coordinate care, to communicate with one another and to collaborate on various initiatives.

This is based on a belief that our systems are designed vertically. We have solutions for housing and for food. The reality is that people live their lives horizontally. All these verticals need to be knitted together for the system to work for individuals. And that is a belief that the CCN is operating on. It is to help individuals navigate the complex health and social systems by connecting people to the resources that they need, when they need it. And the biggest piece of this work is the emphasis on building a comprehensive, active community network.

It's really about our community partners. Effectively, it's about identifying a neutral convener to lead the work in the community for us, to either be a fiscal agent, to develop community governance, to allow the community to own the work. It is really the active community partners who are closest to the issues designing the solutions. And that's been really important for us as we have built these CCNs across multiple communities, across multiple states.

A bright horizon
As a field, we have a long way to go, with telling those stories on how hospitals are improving health equity in their communities. There's so much power in the process of these stories and learning from each other about how to get it done, how to communicate it to different stakeholders, both within the hospitals and as we're thinking about building partnerships with community stakeholders. At the breakout session in October, Julia and Ji will be diving more into the work that's happening at CommonSpirit, how they’re trying to frame things at AHA, and how to tell the stories of the important work that hospitals are doing.

Learning More  

  • AHA’s framework and additional resources on societal factors that influence health can be accessed here:  
  • To listen to the in-depth conversation on this topic with Julia Resnick and Ji Im check out the recent SHSMD Rapid Insights podcast, “Making Societal Factors Part of a Health Equity Strategy”  
  • Register today to attend this session and many others at SHSMD Connections Virtual Conference, October 19-21 online. View the full agenda here. See you online!  
  • SHSMD members can also share resources, ideas and questions with peers in the MySHSMD community.  
  • Nonmembers, learn more about SHSMD and join.  
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