Emerging Strategies to Ensure Access to Health Care Services: Addressing the Social Determinants of Health

The AHA Task Force on Ensuring Access in Vulnerable Communities examined ways in which the access to and delivery of care could be improved. During that process, the Task Force grappled with the reality that, in vulnerable communities, even if quality care is available, social determinants often prevent individuals from being able to access health care or achieve health goals. These social determinants are described in more detail below.

While there are many ways providers could engage to help address the underlying social conditions affecting their patients, the Task Force identified three general paths:

Screening and information: Providers could systematically screen patients for health-related social needs and discuss with patients the impact this may have on their health.
Navigation: Providers could offer navigation services to assist patients in accessing community services.
Alignment: Providers could partner with community stakeholders to align more closely local services with the needs of patients.

Determinants of Health

The World Health Organization defines social determinants of health as the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.¹ While not a complete list, the AHA has identified the following social determinants of health:

Economic Stability: Food security, housing, employment and income/poverty level
Neighborhood and Built Environment: Quality of housing, food access, violence, crime/public safety, environment (clean water and air or pollution), healthy workplaces, schools and transportation
Education: Language and literacy, educational attainment and early childhood development
Social and Community Context: Social support, social cohesion, civic engagement, faith-based communities and incarceration
Health and Health Care: Access to primary, specialty and emergency care, affordability, health literacy, quality of care and insurance coverage
Biology: Genetics, race/ethnicity, gender identity and sexual orientation
Health Behavior: Personal health practices and behaviors (eating, exercise, sexual practices, etc.)