Hospitals are screening for social determinants of health, but community programs and partnerships are lagging behind

The study examines hospital strategies for social needs during the COVID-19 pandemic.

Hospitals are integrating screening to assess patients’ social determinants of health (SDOH), but community programs and partnerships to address SDOH have been slower to develop.

The pandemic has sparked public interest in addressing social needs and health systems have made substantial investments to do so, says the study “Assessment of Strategies Used in US Hospitals to Address Social Needs during the COVID-19 Pandemic”, published on October 21, 2022, in JAMA Health Forum. The researchers used data from the American Hospital Association’s 2020 survey to assess which strategies have been used by rural hospitals, critical access hospitals (CAHs) and safety net hospitals (SNHs).

Three areas to look into

Among 4,295 hospitals, 2,734, or 64%, reported strategies for three areas:

  • Screening for nine types of SDOH: housing, food insecurity or hunger, utility needs, interpersonal violence, transportation, employment or income, education, social isolation, and health behaviors.
  • Creating programs or interventions to address them.
  • Work with external community partners to address SDOH, participate in community health needs assessments or implement SDOH initiatives. There have been 14 collaborations, including joint efforts with other health care providers, health insurers, local or state departments or organizations dealing with public health or social services, religious groups, food pantries, and organizations offering housing insecurity assistance , transportation or legal assistance.


In the results, rural hospitals were screened for a similar number of social needs than urban hospitals, but they implemented fewer programs or interventions and had fewer community partnerships to address SDOH.

CAHs were screened for a similar number of SDOHs than non-CAHs, but they also addressed fewer social needs and formed fewer community partnerships. There were no significant differences between SNH and non-SNH for screening, but SNHs had fewer partnerships with the community.

The findings “suggest that rural hospitals, CAHs and SNHs are not doing more and, in some cases, are engaging in fewer strategies to address SDOH of their vulnerable populations, especially as regards partnerships with communities.” , the study states. “This discovery may be attributable to limited financial resources, workforce constraints, limited community resources and institutional partnerships and a lack of incentives.”

Further research

The researchers cited another study, “Quantifying Health Systems’ Investment In Social Determinants Of Health, By Sector, 2017-19”, published in February 2020 by Health affairs.

The analysis found that 57 health systems with 917 hospitals had invested at least $ 2.5 billion in health system money to create 78 unique programs focusing on employment, education, food security, social and community environment, and transportation.

“Health systems are making substantial investments in the social determinants of health,” the study says. But he noted that overall spending on US health systems community benefits is estimated to be over $ 60 billion annually.

“Historically, hospitals have tended to provide community benefits through uncompensated or subsidized care rather than through investments in activities not directly related to health,” the study says.

While some SDOH programs and interventions have benefited patients’ health outcomes, there is generally little evidence of improved health outcomes. For this reason, health systems are much more likely to develop screening and referral programs than investing directly in SDOH programs, the study says.

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