SHADAC Expertise

Health Equity and Social Determinants

Health Equity and Social Determinants

Health equity and social determinants of health (SDOH) are rapidly growing fields of public health research. Improvements in health equity depend on a better understanding of health disparities and efforts to reduce avoidable differences in health outcomes as well as other conditions, such as access to safe housing, healthy food, transportation and jobs, SHADAC’s approach to this work includes projects that examine access and coverage indicators and categories of social determinants such as housing affordability, educational attainment, and income inequality by breakdowns such as age, race/ethnicity, coverage type, and disability status for individual or multiple state populations. Additionally, our researchers have focused on developing technical resources for states, such as how to use federal survey data to better understand and address SDOH and equity issues and examples of state approaches to risk adjustment based on social factors, as well as producing new equity and SDOH measures on our State Health Compare data tool.

Relevant SHADAC work:
Click on any title below to learn more about the project.

Affordability and Access to Care in 2018: Examining Racial and Educational Inequities across the United States
As health care costs and health care spending continue their simultaneous rise across the United States, record numbers of Americans are reporting either delaying or skipping needed medical care due to cost. A SHADAC study—building on a previous analysis from our “Measures that Matter” series using estimates from two data sets on SHADAC’s State Health Compare—examines issues of affordability and access to care across the U.S. in 2018, with a focus on racial and educational inequities.

Housing Affordability Matters: Measuring and Addressing the Burden of Unaffordable Rents
An analysis by SHADAC examines a key social determinant of health factor—housing affordability—looking specifically at the percent of rental households that spend more than 30% of their monthly income on rent. A lack of affordable housing contributes to housing instability and homelessness, both of which are strong predictors of higher health care costs and poor health outcomes, among others. This measure is available on SHADAC’s State Health Compare for all states from 2012 through 2018 and can be broken down by household income, Medicaid enrollment, race/ethnicity, disability status, and metropolitan status.

Expert Perspective: States’ Reporting of COVID-19 Health Equity Data
States’ Reporting of COVID-19 Health Equity Data looks in-depth at which states are reporting data on the impacts of COVID-19 on vulnerable populations, including communities of color, low-income populations, and residents of congregate living facilities. Also included are interactive maps that explore the extent to which states are reporting data breakdowns by age, gender, race, ethnicity, and locational levels (ZIP code), group residence type, and for health care workers.

State Approaches to Risk Adjustment Based on Social Factors and Strategies for Filling Data Gaps
A State Health & Value Strategies (SHVS) brief, authored by SHADAC researchers, details three approaches taken by organizations in two states, Minnesota and Massachusetts, to solving a key challenge to risk adjusting based on social factors: Where to find data on social risk factors? The brief’s profiled examples employed three approaches to filling the data gap—using survey data, using claims and administrative data, and using a combination of both.

Leveraging American Community Survey (ACS) Data to Address Social Determinants of Health and Advance Health Equity
In this issue brief for the Robert Wood Johnson Foundation’s State Health and Value Strategies, SHADAC explores how researchers, policymakers, and state Medicaid programs can use data from the American Community Survey (ACS) to inform and target interventions that seek to address social determinants of health (SDOH) and advance health equity. The brief also provides examples of states that use social determinants of health and health equity measures from the ACS, including which measures are used and what they are used for.

Latino Children in California Face Inequitable Access to Care
Despite representing more than half of children living in California, Latino children are less likely than white children to: have health insurance coverage, have insurance benefits that meet their needs, find their health care costs reasonable, have a usual source of care, and have had a preventive medical visit in the last twelve months. The infographic presented here illustrates the 2016 National Survey of Children’s Health (NSCH) estimates for these measures for both Latino and white children and also compares California’s performance to other states on the percentage of Latino children who have a usual source of care.