CDC to stakeholders: It's time for us to take our place at the data table.
What stakeholders already know: COVID affected some populations more severely and disproportionately than others.
What stakeholders have been reminded of: The pandemic was a redux wake-up call that non-clinical drivers of heath (also known as the social determinants of health, or SDOH) impact 80% of health outcomes.
What the government is doing about it: A CDC workgroup dedicated to SDOH has identified three specific SDOH data use cases.
The CDC acknowledges its lags
A February 2022 article from HealthLeaders highlighted: "Most state HIEs have, from the get-go of COVID, been able to answer all of the major questions that have somehow befuddled [the Centers for Disease Control and Prevention]. Who's getting affected? What is recovery? What is immunity? What are comorbidities? What things work? We have vast data stores on that, and huge statistical significance over all populations."
As Don Rucker, former chief of the HHS Office of the National Coordinator, notes in the article: "By contrast, the CDC has been unable to use huge silos of its own data to answer these questions in a timely fashion."
As the primary public health authority in the U.S., the CDC should be at the data forefront and has now stated: "[W]e felt that it was important to be at the table, and to be developing the public health use cases about how this information on social determinants of health on social needs could be interpreted by public health and used by public health for decision-making."
This quote from Karen Hacker, MD, MPH, director of the agency's National Center for Chronic Disease Prevention and Health Promotion, marked the April launch of the CDC SDOH Public Health Use Case Workgroup.
The three CDC use cases
Beyond the pandemic, there is not a healthcare stakeholder in the U.S. that is not thinking about, talking about, and—best case scenario—attempting to integrate SDOH as part of its outcomes strategy and business model.
It's fair to say that cloud computing, 5G, and Fast Healthcare Interoperability Resources have been the missing link for efficient data exchange. Maybe that's why the CDC is now in a position to target use cases based on "the functionality and interoperability required to allow an end-user to send and exchange coded SDOH-related data." Those use cases are:
- Community Health Needs Assessment [CHNA] Leveraging Individual Level Social Care Data
- Assessment of State, Local and Territorial Health Department Diabetes Programs
- Monitoring Federal Program Successes for Individual, Program, and Population Health Advancement
Why these three? The prevalence and high-cost of diabetes, and the government's need to improve federal program outcomes—including value-based care models—are obvious.
But what about the CHNA? The assessment—which hospitals are required to complete the assessment every three years, uses community input and multiple data sources, including and increasingly third-party SDOH data—helps prioritize community need on the road to effective interventions. And while a robust CHNA is not the same thing as an overall health equity strategy, the assessment has new importance in the SDOH era.
SDOH priorities often focus on food, housing, and transportation. Other target areas include finance and literacy (both health and digital). The CDC's five SDOH domains include Food and Nutrition Security but are otherwise, and logically, more systemic:
- Built Environment. The human-made surroundings that influence and drive community and individual health.
- Community-Clinical Linkages. Connections between "health care systems and services, public health agencies, and community-based organizations to improve population health."
- Social Connectedness. "[T]he degree to which individuals or groups of individuals have and perceive their desired number, quality, and diversity of relationships that create a sense of belonging and being cared for, valued, and supported."
- Tobacco-Free Policy. Policies that are "population-based, preventive measures to reduce tobacco use and tobacco-related morbidity and mortality."
The CDC focus areas highlight the distinction between individual, community, public, and population health, with some emphasis on industry and interpersonal system support. For example, Community-Clinical Linkages is more about how stakeholders work together to achieve SDOH goals. Social Connectedness seems unique among the CDC's defined SDOH objectives, and yet combating loneliness—particularly for seniors—has been a priority for multiple stakeholders during the pandemic.
Bringing stakeholders together in an efficient way is on the CDC's radar and was part of its SDOH Public Health Use Case Workgroup announcement. The agency's director of the Office of Informatics and Information Resource Management, Timothy Carney, PhD, MPH, has stated:
"We recognize that there are a lot of organizations, entities, activities, and individuals who are doing front-line work on social determinants and health equity … [M]any of us are building systems, solutions, technology applications, strategy, policies, etc. The hope however, is that we can identify a common framework, a future state diagram that all of us can begin to point to."
Laura Beerman is a contributing writer for HealthLeaders.
Recognizing its lags, the Centers for Disease Control & Prevention is joining interoperable data exchange advances by defining three uses cases for social determinants of health data.
The uses cases include hospital, health department, and federal program activities.
The goal is to prevent duplication of effort as multiple stakeholders build response mechanisms for SDOH.