National Health Center Week 2019:Today's Focus: Social Determinants of Health
In the search for innovative solutions to skyrocketing health care costs and the rise of preventable chronic conditions like heart disease and diabetes, the broader medical community is embracing a concept at the core of community health centers: the social determinants of health.In the search for innovative solutions to skyrocketing health care costs and the rise of preventable chronic conditions like heart disease and diabetes, the broader medical community is embracing a concept at the core of community health centers: the social determinants of health.
Community health centers operate using a unique care model, which has addressed the social determinants of health since the creation of the first health centers more than 50 years ago. Inspiration for the health center model came from a trip that Dr. Jack Geiger made to South Africa in the 1950s. Dr. Geiger was struck by the success of a Community-Oriented Primary Care (COPC) model because it helped address health disparities in apartheid South Africa by combining preventive and primary care with population health. Under this model, care teams focus not only focus on the health of patients but their families and communities, as well.
In the 1960s, as part of President Lyndon Johnson's War on Poverty, Dr. Geiger and Dr. Count D. Gibson Jr. founded the nation's first community health centers in a public housing project in Dorchester, Mass., and in Mound Bayou, Miss., a rural area in the Mississippi Delta. These pioneering health centers tackled the most pressing needs of their impoverished communities, including hunger, poor sanitation, and unemployment. For example, staff at the Mound Bayou health center helped improve nutrition by establishing a community farm co-op to grow fresh produce. Staff also reduced water-borne illnesses by installing water pumps and sanitation facilities. 
What Dr. Geiger and Dr. Gibson so keenly recognized was that health is shaped by myriad factors other than medical care. Research indicates that only about 10% of a person's health is directly tied to medical care. The remainder is attributable to genetics (30%), individual behavior (40%), and social and environmental factors (20%). Those social and environmental factors are also known as the “social determinants of health.”
The social determinants of health are the conditions in which people are born, live, work, and age. These include factors such as safe neighborhoods, access to nutritious foods, stable employment, secure housing, and welcoming communities. For example, it is much harder for people to eat healthy foods and to exercise if they can't afford to live in neighborhoods with grocery stores and parks, or if they don't have transportation to access those resources.
Although the term “social determinants of health” wasn't used at the time, health centers have been incorporating those factors into their care models from the very beginning. This revolutionary approach to care for the whole person and entire community continues across the 29 health centers in Tennessee and their approximately 200 care delivery sites. Tennessee's health centers integrate social determinants into the care they provide to more than 435,000 patients per year, many of whom experience multiple social determinants that make it hard for them to live healthy lives. For example, a health center patient may be low-income and lack permanent housing or a reliable mode of transportation, which makes it difficult for them to manage high blood pressure and diabetes.
One way health centers address the social determinants of health is by offering enabling services, which are non-clinical services that support access and delivery of medical and social services. Enabling services vary from one health center to another, but can encompass things like child care, eligibility assistance, food banks or meals, parenting classes, and education and employment assistance.
Health centers in Tennessee commonly offer services like case management, eligibility assistance, language interpretation, and outreach to break down barriers to care and help patients remain healthy in the first place. Many health centers provide additional programs that address more targeted needs. For example, some health centers partner with local food banks to provide food pantries or boxes of food staples on site to combat food insecurity. Health centers also strengthen families by working with organizations to provide parental support services including counseling and workshops. More specific programs help target the social determinants of health for certain patient populations. For example, at least one Tennessee health center offers residential and non-residential programs for survivors of domestic violence to provide them with a safe and secure environment and resources to help them take their next steps. Several health centers offer programs that specifically serve people experiencing homelessness to provide them with medical care and wraparound services that address social needs. Still another health center provides residential programs for adults living with disabilities to increase their independence and facilitate community involvement.
Health centers are so successful at identifying social determinants and developing tailored programs because they are deeply connected to their communities. Health centers are governed by patient-majority boards and get much of their staff from within the community. Health centers often leverage their connections and partnerships with other community organizations to successfully serve their patients and their communities.
During National Health Center Week 2019, from August 4-10, health centers across the country and in Tennessee have been raising awareness of their mission and accomplishments. We invite you to celebrate all the ways America's health centers are “Rooted in Communities” by joining us at a health center event in Tennessee. We look forward to seeing you!
 Liaw, Winston, Jennifer Rankin, Andrew Bazemore, and William Ventres. 2017. Teaching Population Health. Academic Medicine 92 (3): 419. doi:10.1097/acm.0000000000001552.
 Institute for Alternative Futures. 2012. Community Health Centers Leveraging the Social Determinants of Health. Alexandria, VA. http://www.altfutures.org/pubs/leveragingSDH/IAF-CHCsLeveragingSDH.pd.
 Schroeder, Steven A. 2007. We Can Do Better — Improving The Health Of The American People. New England Journal of Medicine 357 (12): 1221-1228. doi: 10.1056/nejmsa073350.
 About Social Determinants of Health. 2019. World Health Organization. https://www.who.int/social_determinants/sdh_definition/en/.
 Institute for Alternative Futures.