What to know
Public health departments and their partners need to consider how conditions in the places where people are born, live, learn, work, play, worship, and age affect a wide range of health risks and outcomes. These social determinants of health (SDOH), and actions to address the resulting health inequities, can be incorporated throughout all aspects of public health work.
Overview
The 10 Essential Public Health Services (EPHS), updated in 2020 with equity at its center, is a well-recognized framework for carrying out the mission of public health. With more attention to equity and multisector efforts, the revised EPHS is better aligned to current and future public health practice. As such, the EPHS provides a framework within which SDOH can be addressed.
EPHS Breakdown 1 - 2
- Use measures of social and structural determinants of health, such as income, education, and employment to understand the root causes of health disparities and inequities in communities (measures and data available from sources such as County Health Rankings, PLACES, Compendium of Federal Datasets Addressing Health Disparities.
- Ensure community health assessments (CHAs) utilize SDOH measures and benchmarks from national sources, such as Healthy People 2030.
- Engage communities and multi-sectoral partners in CHA efforts.
- Include diverse sources of data and community-level determinants of health in investigations of public health issues.
- Ensure multi-sector partner and community engagement in investigating and addressing health problems, soliciting input, and sharing information.
- Consider the needs of populations who may be at higher risk (e.g., people experiencing homelessness, older adults, people with disabilities) during emergency responses and work with partners, including emergency management agencies, to plan accordingly.
EPHS Breakdown 3 - 4
- Work with community groups to create and deliver effective, culturally and linguistically appropriate approaches, messages, and materials to help address SDOH.
- Ensure the use of appropriate communication channels for the intended population, including disseminating through multisector partners.
- Ensure the use of best practices for clear, equitable, and accessible communication, employing principles of health literacy to inform the public.
- Authentically engage with community groups and people with lived experiences to understand and develop solutions to help address SDOH and improve health.
- Convene, facilitate, or engage in multisector partnerships and coalitions with partners, such as housing, law enforcement, education, and transportation.
EPHS Breakdown 5 - 6
- Champion, support, and leverage policies and laws that affect SDOH and implement policy initiatives that improve health outcomes, such as
- Tenant-Based housing voucher programs that can provide access to better housing and neighborhood opportunities.
- Land reuse planning that can improve community health.
- Tenant-Based housing voucher programs that can provide access to better housing and neighborhood opportunities.
- Develop and implement state/community health improvement plans that include and address the SDOH in collaboration with community partners.
- Collaborate with multisectoral partners to ensure laws which impact SDOH are equitably applied in the community, such as housing eviction laws.
- Develop strategies to ensure enforcement of regulations and laws which impact health, such as housing and health codes to prevent childhood lead poisoning or laws related to injury and violence prevention.
EPHS Breakdown 7 - 8
- Connect eligible community members to health and social services such as
- Medicaid, including its medical, mental health, and housing benefits.
- Temporary Assistance for Needy Families.
- Supplemental Nutrition Assistance Program.
- Medicaid, including its medical, mental health, and housing benefits.
- Collaborate with multisector partners (e.g., transportation, housing) to address and remove barriers to care.
- Ensure health services, including behavioral and mental health services, are culturally and linguistically appropriate.
- Support staff training and development efforts that build health equity skills and teach cultural humility.
- Incorporate responsibilities related to addressing SDOH into position descriptions and performance evaluations.
- Build partnerships with academic institutions to strengthen links between learning about and the practice in addressing SDOH.
EPHS Breakdown 9 - 10
- Use performance management and quality improvement methods to ensure services, policies, and plans effectively address SDOH and contribute to health.
- Promote use of evidence-based practices to address health inequity and demonstrate improved health outcomes; examples include healthy school meals for all , year-round schooling, and tenant-based housing vouchers.
- Establish and use community-based engagement and decision-making structures, such as community-based participatory research designs or participatory budgeting [PDF – 269 KB].
- Actively engage governance bodies (e.g., board of health, health council) to understand and address SDOH in the community.
- Conduct strategic planning and establish organizational health equity policies in ways that utilize health equity frameworks and public health ethics.
- Establish robust information technology services that allow for collection and sharing of SDOH and health equity data.
Content Source:
Public Health Infrastructure Center