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| 7 Jan 2022 | |
| Use Cases |
The U.S. is realizing the effects of failing to address health disparities during the COVID-19 pandemic. For many decades, researchers in the U.S. have observed substantial health disparities by race, ethnicity, income, gender, and age. The underlying factors contributing to these disparities, however, were understudied and lacking in data, which led to faulty reasoning and poor policy design. The COVID-19 pandemic emphasized the tremendous magnitude of these real, existing, and long-standing disparities for subgroups of the American population. Yet because these indicators are in many cases not new, emerging solutions and innovations are increasingly available to identify and reduce disparities as well as improve the health of all Americans. W.E.B. Du Bois, a Black American journalist and sociologist noted in the late 19th century that
“[there] are social problems before us demanding careful study, questions awaiting satisfactory answers. We must study, we must investigate, we must attempt to solve; and the utmost that the world can demand is, not lack of human interest and moral conviction, but rather the heart-quality of fairness, and an earnest desire for the truth despite its possible unpleasantness. ”1
Du Bois challenged the pervasive view at the time that health and disease disparities in the population were due to biological makeup— inherent and immovable—a position held even among those in the medical community.2 He conducted a study to elucidate factors driving Black-White health disparities in Philadelphia using archival data, field observations, and interview data. He then combined his results with administrative data including Census and city health data, placing an emphasis on the importance of collecting observations over time.3,4 He found that health among Black Americans, measured by rates of disease and death, was worse on average than among White Americans. Du Bois observed that the differences were largely attributable to social factors such as higher poverty, poor working conditions, discrimination, and living in neighborhoods characterized by high crime rates and poor housing conditions.5 This work laid the foundations in the U.S. for what are now widely recognized as the social determinants of health (SDOH).
SDOH are nonmedical, social, economic, and environmental factors that influence health, health behaviors, and the uptake of healthcare. SDOH “are considered underlying, upstream, or more fundamental determinants of health and disease and are amenable to change through public policy.”6 Du Bios identified several examples including, “...fresh air, cleanliness, healthfully located homes and proper food.”7 Researchers estimate that SDOH account for 80 percent of health outcomes, compared to medical care which accounts for only 10-20 percent of health outcomes, capturing the attention of academic researchers, public health officials, and policymakers.8,9
As COVID-19 swept across the U.S. beginning in 2020, the vulnerabilities that appeared by age, race and ethnicity, and in rural/urban data reinforced the importance of SDOH.10,11,12,13 Responding to these disparities and to address other sources of social inequality, early in 2021, President Joseph Biden issued an executive order “Ensuring an Equitable Pandemic Response and Recovery,” which established a Task Force to “identify and eliminate health and social disparities that result in disproportionately higher rates of exposure, illness, hospitalization and death related to COVID-19.”14 There is also expressed interest in Congress, including the introduction of the bipartisan Social Determinants Accelerator Act (H.R. 2503) during the 117th Congress. The act would authorize grants to up to 25 applicants from state, local, and Tribal governments and qualified nongovernmental entities who develop plans to target and identify key outcomes in communities with unmet social and health needs. The plans are required to include how to link data across agencies in order to measure the key outcomes and cost savings.15 Clearly, the policy discourse has shifted in recent years to recognize the continued need for analysis to inform policymaking on programs and policies related to SDOH, and also demanding the availability of survey and administrative data to research and address SDOH
