SHADAC Expertise

Social Determinants of Health

Social Determinants

Policymakers are increasingly recognizing the important role that social and economic factors, such as housing, healthy food, and income play in driving health care outcomes. Our researchers have focused on developing technical resources for states, such as how to use federal survey data to better understand and address social determinants of health (SDOH) and equity issues, as well as assessing examples of state approaches to risk adjustment based on social factors. We have also produced a number of new SDOH measures on our State Health Compare data tool.

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

Neighborhood Support Matters for Child Health

Where people live, work, and play has been shown to have important impacts on health. In addition to one’s physical environment (e.g., access to safe schools, parks, and sources of nutritious food), the extent to which people feel connected to a supportive community with a network of resources is an important factor for health. This concept is known as “social capital," and has been linked with a broad range of health outcomes including mortality. This blog uses data from the National Survey of Children’s Health (NSCH) to study the association between supportive neighborhoods and key children’s health outcomes. 

Adverse Childhood Experiences and Implications for Health Equity

Drawing on data from the National Survey of Children’s Health, researchers at SHADAC authored a brief investigating the prevalence of adverse childhood experiences (ACEs) and disparities in ACEs exposure by children’s race, family income, age, and health insurance coverage. The disproportionate impact of ACEs has deep ramifications on health equity due to related research showing that ACEs exposure is associated with increased risk for numerous short- and long-term health impacts, varying from mental health and substance use disorders to heart disease and cancer. Looking at the relationship between ACEs and long-term health could help us better understand different social determinants of health, how these things affect various populations, and could help identify gaps in access & care. 

Monitoring Broadband Expansion and Disparities Using Data from State Health Compare

The onset of the COVID-19 pandemic underscored the importance of telehealth services to people across the U.S. and the crucial role of broadband internet access in providing those services. Telehealth continues to be a popular and often necessary way for patients to access care, and federal and state governments are now making significant investments to expand and ensure affordable access to broadband internet. For these reasons, it is important to monitor changes in the share of the population with broadband internet as an indicator of access to care. SHADAC performed an analysis of 2021 American Community Survey (ACS) data to understand American households’ access to broadband internet - amongst other findings, we found that access to broadband internet has increased by 3.8 percentage points (PP) since 2019. Learn more of our findings in this blog.

Improving Coordination Between SNAP and Medicaid in State Agencies

The U.S. Department of Agriculture’s Food and Nutrition Service (FNS) has contracted with State Health Access Data Assistance Center (SHADAC), as a subcontractor to MEF Associates to conduct a study to examine State-level opportunities for coordination between the Supplemental Nutrition Assistance Program (SNAP) and Medicaid.  The study team will conduct site visits to the study State agencies. Site visits will include semi-structured interviews with staff from the State SNAP agency, State Medicaid agency, local offices, information technology managers or directors, and relevant other community organizations or healthcare providers. The study will identify and describe similarities and differences in State SNAP and Medicaid applications and result in a Best Practices Guide that explains how States can better improve coordination between SNAP and Medicaid.

Past Work

Monitoring Childhood Poverty During and After COVID-19

Childhood poverty has been brought to the forefront during the COVID-19 pandemic, with pandemic restrictions making it harder for families with low incomes to meet the needs of their children. This blog uses estimates from State Health Compare of childhood poverty and provides important pre-pandemic baseline context for future understanding of how the COVID-19 crisis may have impacted children and families who are living in poverty.

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.

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.