Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes

Abstract

Social determinants of health (SDoH) are the conditions in which people live and work that shape access to essential social and economic resources. Calls for healthcare systems to intervene on unmet social needs have stimulated several large-scale initiatives across the country. Yet, such activities are underway in the absence of a unifying conceptual framework outlining the potential mechanisms by which healthcare-based unmet social need interventions can improve health outcomes. Drawing on theoretical foundations and empirical evidence about the relationship between unmet social needs and health, the authors developed the OASIS (Outcomes from Addressing SDoH in Systems) conceptual framework to map the known and hypothesized pathways by which unmet social need screening and referral interventions may impact outcomes. The OASIS framework may help guide policy makers, healthcare system leaders, clinicians, and researchers to utilize a more unified approach in their efforts to implement and evaluate unmet social need interventions and thus foster the development of an evidence base to inform healthcare systems to more effectively mitigate the consequences of unmet social needs. Adopting an overarching conceptual framework for addressing unmet social needs by healthcare systems holds promise for better achieving health equity and promoting health at the individual and population levels.

Keywords: conceptual framework; health equity; healthcare delivery; social determinants of health.

Figure 1

OASIS framework: Outcomes from Addressing SDoH in Systems. Green links are supported by data; blue links need further investigation. Letter “A” indicates that for patients with multiple unmet social needs, resolution of one need may enable them to address another. Reduced competing demands includes freeing up various resources (money, time, energy) to address other needs, which in turn can affect health outcomes. Letter “B” indicates clinical outcomes which may include but are not limited to conditions where adherence to therapy directly impacts outcomes, such as hypertension, diabetes, and asthma. Letter “C” indicates that identification of unmet social needs may be beneficial, even without referring to resources. For patients with transportation problems, for example, delivering prescriptions through mail order can bypass the barrier posed by the unmet transportation need without directly addressing it. Letter “D” indicates that improved outcomes, such as improved well-being, may help patients connect to resources. Letter “E” indicates costs may be reduced through improved control of chronic conditions, such as hypertension, which could avert costly future admissions for stroke or target organ damage. But increased costs to address unmet social needs may affect the equation for other conditions.