The Social Determinants Accelerator Act

August 16, 2021

There is growing acknowledgement that good health depends on more than one’s genetics, lifestyle, and biomedical care. Extrinsic social and economic factors — including access to education, housing, nutritious food, and a safe and unpolluted environment — all play a role in the prevention and management of health conditions. To create equitable healthcare systems, governments must account for the multi-layered and intertwined adversities that their most vulnerable constituents face.1,2 In the U.S. Congress, momentum is building around legislation proposed to address what are known collectively as the “social determinants of health.” On July 15, the House Energy and Commerce Subcommittee on Health unanimously advanced to full committee the Social Determinants Accelerator Act (SDAA, H.R. 2503), along with 18 other bills related to health equity. The SDAA is a bipartisan bill that would help states develop strategies to improve the health of Medicaid beneficiaries by specifically targeting the social determinants of ill-health.3,4

The SDAA would allow the Secretary of Health and Human Services to convene an inter-agency technical advisory council, which would include federal experts from the Department of Housing and Urban Development, the Department of Labor and the United States Department of Agriculture, as well as state and local government officials, the private sector and community-based organizations.5 In consultation with the Council, the Centers for Medicare and Medicaid Services would then distribute up to $25 million in grants to state, local and tribal governments to develop innovative plans to address social determinants of health. These programs would ideally cater to a group of high-need Medicaid patients, such as individuals experiencing homelessness or older workers with chronic conditions. Programs would also be crafted with key outcomes in mind that utilize evidence-based interventions and the coordinated efforts of health and non-health services, which the Council would assist grantees in identifying.5

The SDAA bill was originally introduced, but not passed, by the 116th Congress.6 Instead, key provisions from the bill were incorporated in Fiscal Year 2021 Appropriations. These included $3 million in funding to for the Centers for Disease Control and Prevention (CDC) to establish a Social Determinants of Health Pilot Program, through which grantees could launch Accelerator Plans such as those that the SDAA bill aims to fund.7 Thus far, CDC funding has been distributed to 42 community multi-sector partnerships that address the social determinants of health in one or more of five domains directly linked to chronic disease (built environment, community-clinical linkages, food and nutrition security, social connectedness, and tobacco-free policies).8

Internationally, government-sponsored programs that utilize community resources to promote non-medical aspects of health are gaining traction. Some of these programs have shown promising reductions in use of emergency and inpatient services among patient participants, as well as improvements in reported general wellbeing. However, more systematic and controlled studies are needed to truly evaluate interventions designed to target social determinants of health.9 Thus, a key element of the SDAA is the requirement that grantees include plans for linking and sharing their data, such that their impact on the health can be measured and their return-on-investment for taxpayers can be clearly understood.5 Developing an evidence base for programs focused on social determinants of health is critical to their ongoing support.

Reps. Cheri Bustos (D-IL.), Tom Cole (R-OK.), Jim McGovern (D-MA.), and Markwayne Mullin (R-OK) reintroduced the SDAA bill to the 117th Congress on April 14, 2021 after it was not passed by the 116th Congress.5 Currently, 44 members of Congress are listed as cosponsors, including 38 Democrats and 6 Republicans.3 Dozens of organizations, including the American Hospital Association and American Medical Association, have officially expressed their support for the bill.5 Most recently, Bustos, Cole, Mullin, and G.K. Butterfield (D-NC) launched the bipartisan Congressional Social Determinants of Health Caucus to further promote the SDAA.11 Beyond this growing momentum, the Biden administration and House Appropriations Committee have proposed $153 million in Fiscal Year 2022 to the CDC’s social determinants of health program — a promising indication of the desire for a more holistic approach to healthcare delivery and health equity.4

References 

  1. Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099-1104. 
  1. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129 Suppl 2(Suppl 2):19‐31. doi:10.1177/00333549141291S206 
  1. H.R.2503 – Social Determinants Accelerator Act of 2021. Library of Congress. Published July 15, 2021. https://www.congress.gov/bill/117th-congress/house-bill/2503/all-info  
  1. Roude B, Perleoni A. House subcommittee approves health equity bills. Association of American Medical Colleges. Published July 16, 2021. https://www.aamc.org/advocacy-policy/washington-highlights/house-subcommittee-approves-health-equity-bills  
  1. Social Determinants Accelerator Act. Aligning for Health. https://aligningforhealth.org/social-determinants-accelerator-act/  
  1. H.R.4004 – Social Determinants Accelerator Act of 2019. Library of Congress. Published July 26, 2019. https://www.congress.gov/bill/116th-congress/house-bill/4004/all-info?r=1&s=2  
  1. Social Determinants Accelerator Act provisions included in FY 2021 Appropriations package. Aligning for Health. Published December 22, 2020. https://aligningforhealth.org/social-determinants-accelerator-act-provisions-included-in-fy-2021-appropriations-bill/  
  1. Social determinants of health community pilots. Centers for Disease Control and Prevention. Published May 11, 2021. https://www.cdc.gov/chronicdisease/programs-impact/sdoh/community-pilots.htm   
  1. Social Prescribing. National Health Service, England. https://www.england.nhs.uk/personalisedcare/social-prescribing/  
  1. Pescheny JV, Randhawa G, Pappas Y. The impact of social prescribing services on service users: a systematic review of the evidence. Eur J Public Health. 2020;30(4):664-673. 
  1. Launch of the Congressional Social Determinants of Health Caucus. Aligning for Health. Published July 22, 2021. https://aligningforhealth.org/launch-of-the-congressional-social-determinants-of-health-caucus-webinar-recording/  

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