Recent report from the National Academies of Science, Engineering, and Medicine (NASEM)4 identified five essential activities for the integration of social needs into health care: (1) awareness, (2) adjustment, (3) assistance, (4) alignment, and (5) advocacy. Given the siloing of SDOH from clinical determinants, the NASEM report provides important guidance about how to address social needs in the context of health care service provision. First, awareness indicates the need for screening for SDOH, and adjustment indicates the need to tailor services to resolve the negative determinants and support the positive. Next, assistance and alignment mean both strengthening social supports and redesigning health services to meet the needs of the public. Finally, advocacy includes making use of local, state, and federal governments to support public health efforts in addressing SDOH consistent with clinical care within the context of the communities where the care is provided.

This approach is useful not only for understanding SDOH, but also in moving even farther upstream toward identifying the structural determinants of health: cultural norms, policies, institutions, and practices that define the distribution (or maldistribution) of SDOH. These structures and systems date back to the founding of this nation and its economy on principles of racial, class, and gender hierarchy.5–11 They shape the distribution of power and resources across the population, engendering health inequities along racial, class, and gender lines and intersections. “ – Dr. Joia Crear-Perry et al.