Social Determinants of Health have increasingly filtered into the public health vocabulary over the past few years and, recently, featured prominently in the Healthy People 2030 framework.

Some terminology you may not be as familiar with though, is “social needs.” Social needs and Social Determinants of Health (SDOH), while they sound similar, address two different aspects of a community’s health.

This article discusses what the difference is between the two terms and why it matters. In addition, this article explains why SDOH should be documented and how local health departments can most effectively do that.

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What Are Social Determinants of Health?

The World Health Organization (WHO) defines Social Determinants of Health as, “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

SDOH affect health equity. They can include income and social protection, education, job security, early childhood development, and access to affordable and good quality healthcare services, among other things.

SDOH are the core focus of Public Health 3.0. At the heart of Public Health 3.0 is the idea of upstream interventions and addressing SDOH is upstream intervention.

If you are familiar with “Public Health 3.0”, a term coined in 2016 by Karen B. DeSalvo, MD, MPH, MSc then Acting Assistant Secretary for the US Department of Health and Human Services (HHS), you know that it is meant to describe a progression or “modernization” of public health goals and missions.

Public Health 3.0 is a more sharply defined focus on addressing ALL the factors that affect a person’s overall.

What Are Social Needs

A social need on the other hand, as defined in a Health Affairs article written by Brian C. Castrucci, DrPH, President & CEO of the deBeaumont Foundation and John Auerbach, President & CEO of Trust for America’s Health, is better described as the need of an individual as a result of social determinants of health.

For example, in a December 2020 Tweet, Castrucci asked, “A program to help elderly with transportation issues get to their medical appointments…Are you addressing a social need or a social determinant? What do you think?” As the replies nearly unanimously suggested and Castrucci himself later answered, this was an example of a social need, focused on addressing the needs of individuals.

Another example is provided in an October 2019 Health Affairs article, “… an effort to provide fresh produce to people struggling to afford food mitigates an immediate individual need, but it does not address the underlying systemic issues that cause food insecurity. Imprecise use of the terminology could overstate the reach of the intervention.”

Why Does it Matter?

You may be wondering why the difference in the two terms matters, since they each address a different aspect of the same stream, with SDOH focused further upstream and social needs focused more mid-stream.

The need to differentiate between the two is to ensure that the core meaning of the term “Social Determinants of Health” is not lost. Losing the meaning of that term will lead to a loss of focus on intervening where it matters most, as pointed out in this 2019 article from the deBeaumont Foundation:

“Hospitals and health care systems have started to address these social determinants of health through initiatives that buy food, offer temporary housing, or cover transportation costs for high-risk patients. … If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country.”

“If this is what addressing the social determinants of health has come to mean, not only has the definition changed, but it has changed in ways that may impede efforts to address those conditions that impact the overall health of our country.” — Brian C. Castrucci, DrPH

Upstream interventions have far-reaching effects and maximum impact. Upstream interventions are focused on prevention of problems rather than mediation of social needs after problems have occurred.

Why Document Social Determinants of Health?

Data is what proves or disproves theories. Capturing information on the conditions in which people are born, live, work, and age (as OASH describes SDOH) provides a means of drafting effective upstream interventions.

Where to capture that data? Electronic Health Records (EHRs).

This 2015 article from the Public Health Informatics Institute (PHII) describes the importance of documenting SDOH, expounding on ideas set forth in a 2014 study published by the Institute of Medicine (IOM):

“But, if the IOM’s vision is successful, it could turn EHRs into the cementing agent between public health and health care, delivering the best practices and implicit knowledge of population health research into the hands of health care providers and potentially reducing the prevalence of diseases linked to key social determinants.”

How to Most Effectively Document SDOH

The most effective way to document SDOH is with an EHR that uses a standardized terminology (or standardized taxonomy) such as the Omaha System. Standardized terminology ensures that there are standards for the terms and language used to describe individual clients, groups, populations, conditions, problems, and outcomes.

 

Using a standardized terminology ensures that the data you’re putting into your EHR can be pulled back out in a meaningful way and you can accurately describe your client or population as well as measure the outcomes of interventions and prove your results.

Does Effectively Documenting SDOH Make a Difference?

The ability to provide meaningful data helps you communicate effectively. For upstream interventions to be effective, in fact, for upstream interventions to occur at all, they need to be funded and supported by stakeholders throughout the community. Policy makers and legislators need to be supportive.

For that to happen, the agencies most in a position to identify and document the SDOH in their community (local health departments) need to be empowered to effectively communicate with those policy makers, legislators, and stakeholders.

In an interview last year with Champ Software, Karen S. Martin of Martin Associates stated, “Administrators can use clinical data to help local, state, and national fiscal intermediaries and legislators understand services provided and support the need for continued and increased funding.”

“Administrators can use clinical data to help local, state, and national fiscal intermediaries and legislators understand services provided and support the need for continued and increased funding.” — Karen S. Martin, RN, MSN, FHIMSS, FAAN

Conclusion:

In summary, SDOH are the broader conditions affecting how individuals are born, grow, work, and live. They are the upstream causes that effect mid-stream social needs.

Muddling the meaning of the term “Social Determinants of Health” by confusing mid-stream interventions for social needs will result in a loss of meaning of what SDOH are and lessen the ability of public health departments to drive truly meaningful, long-term change in communities.

Public health departments are uniquely placed to help ensure SDOH are properly identified and documented in their communities by using an EHR with standardized terminology to record SDOH.

This then empowers health departments to advocate for the need for upstream interventions in their communities, with evidence-based data they can share with stakeholders, legislators, and policymakers.

Next Steps:

Contact us today to find out how Nightingale Notes EHR, built on the Omaha System standardized terminology, can help you document SDOH in your community.

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