I heard a story last week from one of our clinical partners about a woman with late stage cancer who disclosed to hospital staff that she and her teenage son did not have enough food to eat. The staff member called Child Protective Services, probably with the intent of helping the patient and her son, but instead she had the fairly negative impact of scaring the patient that her son might be taken away from her during her final weeks of life.
Negative unintended consequences (find other examples here annfammed.org/content/17/1/77....) are more likely when the people most affected by initiatives focusing on individual-level social needs and/or community-level social conditions are not adequately represented in decision-making.
So, while I think it is critical that doctors and healthcare organizations engage with SDoH both at individual and community level to improve health outcomes, we need to make sure we are always doing it in partnership with patients and community residents.

There is a large body of research that shows addressing social needs can improve patient health outcomes and patient satisfaction:
-The Social Interventions Research and Evaluation Network (SIREN) has an evidence library of over 800 studies that assess the impact of SDoH interventions: sirenetwork.ucsf.edu/tools/evi....
-In addition, Commonwealth Fund researchers created an evidence guide on the impacts of SDoH interventions in 6 categories (housing, nutrition, transportation, home modification, care management, and counseling): commonwealthfund.org/sites/def....
-We completed a similar literature review on care models targeting complex patients that incorporated social needs interventions: commonwealthfund.org/publicati...

However, as Dr. Francis pointed out, social needs interventions could have negative outcomes, particularly if they are not designed and implemented carefully, with these concerns in mind. The first step is providers including patients and their caregivers in these discussions - from explaining the impact of social factors on health, to deciding on next steps. Safeguards surrounding use of social needs data are also needed to protect patients.

I agree there is substantial research that demonstrates the positive health impacts of addressing social needs and/or social determinants. Just yesterday, the Bipartisan Policy Center released a report focused on "health in all policies," which covered areas such as education and employment, and recommended that federal policymakers take into account the broader SDoH impacting health status. You can find the report here: bipartisanpolicy.org/report/he...

I think what we call SDoH is too broad a category to be that helpful. I like to break down the SDoH into social needs and social conditions. Social needs speak to the actual needs that patients and their family’s face that affect health- hunger, homelessness, under insurance, family poverty, transportation as examples. Then there are the social conditions- the conditions under which people work, live, go to school, and play that drive social need. Here we are more focused on the “determinants of the social needs” things like poverty, employment ,structural racism, school quality, housing quality and affordability and other neighborhood factors. I like to call those the economic, political, and societal determinants of health. We do a disservice by lumping social needs and social conditions as the solutions are different. And of course, the measures vary when we are looking at social needs or social conditions.

Broadly speaking, the social determinants of health are the environmental conditions and circumstances that a person lives in that have an impact on their health. They can range from the physical features of the neighborhood one lives in, to cultural and social factors that drive inequities. As Dr. Ansell pointed out, the "social determinants of health" may be too broad, and too big, for the health care system to tackle. Therefore, there is increasingly a focus on "health-related social needs", which are the tangible and actionable social needs of patients that the health care system can assess for and address to improve health outcomes. These include things like ensuring patients have access to nutritious foods, transportation, and stable and safe housing.

I agree with my colleagues about the need to distinguish between social needs and the social determinants of health. I would recommend a review of this Health Affairs blog: healthaffairs.org/do/10.1377/h...

For example, addressing home modifications (social need) is different than providing affordable housing (social determinant of health). Providing home-delivered meals (social need) is different than increasing the availability of affordable nutritious food in neighborhoods (social determinant of health). Facilitating ride-sharing (social need) is different than urban planning to foster walkability and multiple transportation modalities (social determinant of health).

Social needs focus largely on meeting individual needs versus social determinants have an even more upstream focus which tend to influence communities and populations at large.

While the health care sector has focused largely on the former to date, many health systems and payers are beginning to see value to move even more upstream.

One need which is within the scope of the hospital is transportation to medical appointments. This can also benefit the health system by preventing missed appointments. See this case study: himss.org/news/removing-patien...