To Level the Playing Field, Congress Must Address the Social Determinants of Health

By Chrissie Juliano, MPP, Executive Director

This blog was originally published by the Coalition for Health Funding in the “What the Funding” series.

A recent article in The New York Times found that a neighborhood in East Harlem is experiencing temperatures up to 30 degrees hotter than a neighborhood a few miles away. The reason? The East Harlem neighborhood was developed without trees. Beyond the obvious discomfort of a scorching summer day, these disparities can have real, long-term health effects.

In large cities, residents experience stark disparities in income, education, exposure to violence, transportation, and access to quality healthcare. These conditions in which people are born, live, work, and play, known as the social determinants of health (SDOH), directly impact the quality and length of life.

Just as COVID-19 has upended every facet of our lives, the pandemic also compounded issues related to the social determinants of health.

Throughout the past year, lower-income individuals were more likely to experience challenges related to the economic downturn. According to Human Rights Watch, “Low-income households were particularly likely to have lost work or income. Among households making less than $35,000 a year, 57.3% experienced income or employment loss during the pandemic, compared with 34.6% of those making more than $150,000 a year.”

Congress can and should do more – through consistent funding over time – to enable communities to address SDOH so they can be healthier and more resilient.

Interventions targeting the SDOH could have a tremendous impact on the health and well-being of many people by preventing hardship before it happens. Local public health departments understand these conditions and are working tirelessly to eliminate the inequities resulting from social injustice. Despite their collective resolve, these departments are stretched thin. Many lack the staffing and funds to adequately address SDOH. All of them continue to dedicate significant resources to combatting COVID-19.

At the Big Cities Health Coalition, we advocate for a stronger, fully funded public health system. We also believe that funding should be sustained to effectively advance equity and health for decades to come. An ounce of prevention, as they say, is worth a pound of cure. We must invest more in preventing poor health and promoting policies and practices that support good health. This requires sustained and substantial investments in the health of communities, including a livable wage, paid leave, safe and healthy housing, and access to critical infrastructure like lead-free pipes and sidewalks.

Recently, the Centers for Disease Control and Prevention (CDC) awarded funds to develop community health pilots that seek to identify and learn from multi-sector coalitions with demonstrated success addressing the social determinants of health. At Big Cities Health Coalition member cities, local health departments and community organizations are putting this funding to good use.

• In Indianapolis, Marion County Public Health and other local organizations formed “Health by Design,” a coalition dedicated to making the city more walkable and accessible.
• In the Philadelphia area, the Southeastern Pennsylvania Tobacco Control Project is reducing health disparities through comprehensive tobacco control, treatment, and training.

These pilots feature partnerships with community organizations that can provide direct, on-the-ground services to their constituencies, and broad focus, understanding that the health of a community is a complicated, interconnected challenge.

The CDC currently receives just $3 million in congressional appropriations to conduct interventions targeting SDOH. With additional funding, CDC could expand these community pilots, initiate a national SDOH intervention plan, provide technical assistance to communities, and continue to build the evidence base through improved data collection to better understand health disparities. A comprehensive approach is needed, with sustained funding, to be able to move the dial on health disparities and build healthier communities.

The President’s 2021 budget requested and the House FY2022 Labor-HHS-Education Appropriations bill includes $153 million to address social determinants of health, a significant increase over the current funding allocation. This funding could catalyze community health and provide more stable housing, a stronger economic safety net, better transportations systems, and stronger schools. This funding must be considered in tandem with the critically important infrastructure bill, which can support the types of things that are also needed to protect and promote the health of communities.

Public health needs to be a top priority for our lawmakers — in times of crisis and as we address routine challenges. My colleagues at BCHC and I urge Congress to support this historic increase in funding to address the social determinants of health and put our country on a path to a more equitable and healthier future.