Hospitals screen for social determinants of health, but programs, community partnerships lag behind

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

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

The pandemic has sparked public interest in meeting social needs, and health systems have made significant investments to do so, says the study, “Evaluating Strategies Used in US Hospitals to Address Social Needs During the COVID-19 Pandemic,” published on 21 October 2022, c JAMA Health Forum. Researchers used data from a 2020 American Hospital Association survey to assess what strategies were used by rural hospitals, critical access hospitals (CAHs) and safety network hospitals (SNHs).

Three areas of research

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.
  • Working with external community partners to address SDOH, participating in community health needs assessments or implementing SDOH initiatives. There were 14 partnerships, including collaborative efforts with other health care providers, health insurers, local or state departments or organizations involved in public health or social services, religious groups, food pantries, and organizations offering assistance with housing insecurity, transportation or legal aid.


In the findings, rural hospitals screen for a similar number of social needs compared to urban hospitals, but implement fewer programs or interventions and have fewer community partnerships to address SDOH.

CAHs screened for a similar number of SDOHs compared to non-CAHs, but also addressed fewer social needs and created fewer community partnerships. There were no significant differences between SNHs and non-SNHs for screening, but SNHs had fewer community partnerships.

The results “suggest that rural hospitals, CAHs, and SNHs are not doing more, and in some cases, engaging in fewer strategies to address the SDOH of their vulnerable populations, particularly with regard to community partnerships,” the study said. “This finding may be due to limited financial resources, workforce limitations, limited community resources and institutional partnerships, and a lack of incentives.”

Additional research

The researchers cite another study, Quantifying Health Systems Investments in the Social Determinants of Health, by Sector, 2017-19, published in February 2020 by Health matters.

This analysis found that 57 health systems with 917 hospitals invested at least $2.5 billion from the health system to create 78 unique programs focused on employment, education, food security, social and community contexts, and transportation.

“Health systems are making significant investments in social determinants of health,” the study said. But it notes that the total welfare costs of US health care systems are estimated at more than $60 billion annually.

“Historically, hospitals have tended to provide community benefit through uncompensated or subsidized care rather than investment in non-health-related activities,” the study said.

Although some SDOH programs and interventions have benefited patient health outcomes, overall evidence of improvements in health outcomes “is sparse.” Because of this, health systems are much more likely to develop screening and referral programs than to invest directly in SDOH programs, the study said.

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