The Need for Community Driven Approaches to Reduce Health Disparities by Addressing Social Determinants of Health

The Center for Disease Control (CDC) interim report on Healthy People 2020 results indicated that among 195 identified disparity objectives only 24 areas showed improvements, 14 registered a decline in disparity markers and 157 revealed no changes at all. An Institute of Medicine round table discussion indicated the lack of progress in reducing some health disparities feed into the growing concern that current resources and efforts are not yielding effective and scalable solutions. A common theme among underperforming initiatives is the lack of coordination and significant community-based involvement. Specifically cited were the following underlying concerns:

• Lack of community voice, support and participation that is needed for long term sustainable results,
• Lack of engagement in developing community-based strategies from strategic stakeholders needed to address know determinates like, housing, law enforcement, education and community-based services providers.
• Lack of a governing platform that manages roles, responsibilities, financing, evaluation and reporting across the spectrum from planning to implementation to evaluation.

Although improved clinical pathways or approaches experience some success in disparity reduction because of enhanced protocols and increased knowledge regarding health and disease among racial/ethnic populations, limitations exist due to unaddressed social determinants.

The importance of addressing the social determinants of health is clearly indicated in Healthy People 2020 goals and objectives. One of HP 2020 goals is to “Create social and physical environments that promote good health for all”.  The acceptance of the importance of social determinates on health outcomes is further shared by the World Health Organization, whose Commission on Social Determinants of Health in 2008 published the report, Closing the gap in a generation: Health equity through action on the social determinants of health. The need to address SDOH to reduce health disparities is also shared by other U.S. health initiatives such as the National Partnership for Action to End Health Disparities and the National Prevention and Health Promotion Strategy.

Every American deserves an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture. The CDC recommends making these advances involves working together to:

• Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities.
• Establish common goals, complementary roles, and ongoing constructive relationships between the health sector and these areas.
• Maximize opportunities for collaboration among Federal-, state-, and local-level partners related to social determinants of health.

Regardless of which social determinant of health domain that you focus your time, energy, and resources to make an impact, it must include strong community based involvement to increase the likelihood of success and sustainability. Engaging communities goes beyond typical stakeholder engagement. It requires a long term phased in process that includes introduction, presence and validation, partnership development and strategy deployment. Within each of these areas are specific steps to accomplish before moving onto the next phase. Without it, 20 years of addressing disparities has taught us that success, if obtained at all, will be fleeting.