To a large degree, health is shaped by the conditions in which people are born, grow, live, work, and age, collectively termed the social determinants of health.^1,2 US public and health care professionals care about improving health outcomes. Compared with other high-income countries, the US spends significantly more per capita and in total on health care.³ Yet through chronic underinvestment in some of the conditions that most influence health, such as social services, education, physical environments, and access to healthy food, progress has been undermined, with lower-than-average outcomes across a range of health indicators, including a recent decline in life expectancy.

While perhaps slow to respond to this challenge to the health of populations, in the last decade, hospitals and physicians in the US have begun to address social determinants of health. According to a 2017 survey of 284 hospitals, 80% of respondents, including clinical and administrative staff across leadership levels, indicated that “leadership was committed to establishing and developing processes to systematically address social needs as part of clinical care.”⁴ This often includes partnering in some way with community organizations to improve access to housing, food, transportation, or social services to patients who may have difficulty with access to health care. The American Hospital Association has published a toolkit on “how hospitals can address the social determinants of health in their communities” including helping to address food insecurity or transportation costs.”⁵ Whether any of these initiatives, regardless of how well intentioned they may be, are effective is unknown.

There are several reasons for this. Physicians and hospitals understand that health is shaped by these broader conditions and are genuinely motivated to improve them as part of their responsibility to community health. With the enactment of the Affordable Care Act, hospitals have clear incentives to monitor and address community needs. Mitigating the social determinants of health may help accountable care organizations reduce costs and meet value-based-care goals, such as mitigating risk of readmission or medication nonadherence. At its core, for many health care organizations, addressing social determinants is born of frustration with the often-demoralizing alternative: treating people only to send them back to the conditions that contributed to their health problems.

在很大程度上，健康取决于人们出生，成长，生活，工作和年龄的条件，这些条件统称为健康的社会决定因素。^{1 ，2名}美国公众和卫生保健专业人员关心改善健康状况。与其他高收入国家相比，美国在人均医疗保健方面的总支出显着增加。³然而，由于在对社会健康，教育，自然环境和获取健康食品的影响最大的某些状况下，长期投资不足，进展受到了损害，一系列健康指标的结果低于平均水平，包括最近的预期寿命下降。

在过去的十年中，虽然对人群健康的挑战可能反应缓慢，但在美国，医院和医生已开始着手解决健康的社会决定因素。根据2017年对284家医院的调查，包括领导层的临床和行政人员在内的80％的受访者表示：“领导层致力于建立和开发程序，以系统地满足社会需求，作为临床护理的一部分。” ⁴这通常包括以某种方式与社区组织合作，以改善可能难以获得医疗保健的患者获得住房，食物，交通或社会服务的机会。美国医院协会已经发布了关于“医院如何解决社区健康的社会决定因素”的工具包，包括帮助解决粮食不安全或运输成本。⁵这些举措中的任何一项是否有效，无论其意图如何，尚不清楚。

有几个原因。内科医生和医院知道，健康是由这些更广泛的条件所决定的，并且真正有动力去改善这些状况，这是他们对社区健康的责任的一部分。随着《平价医疗法案》的颁布，医院有明确的动机来监测和解决社区需求。减轻健康问题的社会决定因素可能有助于负责任的护理组织降低成本并实现基于价值的护理目标，例如降低再次入院或药物不依从的风险。对于许多医疗保健组织而言，其核心在于解决社会决定因素，这源于沮丧和沮丧，因为他们常常贬低别人的道德：只对待人们，使他们回到导致其健康问题的状况。