How Federal Agencies Can Improve the Health and Well-Being of Americans


In 2020, life expectancy in the United States fell to its lowest level since 2003, ranking 26th out of 35 OECD countries despite having advanced medical technology and higher health care spending than any other country. . Traditional medical care is not enough to improve these sobering statistics. Public health experts are now focusing on the role of social determinants of health, factors related to where Americans live, work and spend their free time. Factors such as employment status, education, income, housing, food security, transportation, and environment can have a major impact on health outcomes. Federal agencies responsible for these and other aspects of American life have the opportunity and responsibility to integrate SDOH into their missions and work.

The Department of Health and Human Services has made improving the SDOH a high priority. HHS has incorporated SDOH into Healthy People 2030, an ambitious agenda that sets data-driven national goals for health and wellness. HHS brought in outside experts to help develop Healthy People 2030 and engaged federal agencies through the Social Determinants of Health Task Force.

Last September, HHS and the nonprofit Center for Open Data Enterprise co-hosted a roundtable building on this work by bringing together experts from different industries for discussions about improving SDOH. This Roundtable on Intersectoral Collaboration on Social Determinants of Health showed how the different aspects of SDOH are interrelated.

The roundtable also identified cases that demonstrate how SDOH factors in different sectors can affect health and well-being, and how federal agencies could address them. For example, recent work by the Federal Transit Administration has demonstrated the importance of transportation to health care access, health, and well-being. The Department of Transportation could apply these learnings to improve transportation options for the benefit of health. The agency could support programs to connect communities far from health facilities to reliable and affordable transportation, or develop infrastructure such as sidewalks and bike lanes that make it easier to exercise.

Transportation options can be closely tied to location and the quality of people’s housing. Substandard housing, often compounded by environmental factors, has a negative impact on health and well-being. According to a 2017 assessment by the Government Accountability Office, 15% of rental properties have problems, including rodent infestations, water leaks and faulty heating, which combine with environmental factors like cold or bad weather. air quality to harm health. The Department of Housing and Urban Development could set SDOH-focused goals for lead reduction, indoor air quality, air conditioning for residences at risk of extreme heat, and other factors. It is essential to proactively address these issues, many of which are compounded by climate change.

In fact, climate change acts as a threat multiplier across SDOH. The National Oceanic and Atmospheric Administration, the Federal Emergency Management Agency, and the White House Office of Science and Technology Policy are already exploring ways to expand and improve climate information and services for the public about risks such as fires, floods and drought. They can look at these issues through an SDOH lens and develop specific goals and targets to address the impacts of climate hazards on health and SDOH.

CODE’s report on the roundtable includes a number of opportunities for action for federal agencies to improve SDOH conditions for all Americans. CODE also publishes a cross-industry SDOH data hub that shows the wealth of data on SDOH factors that already exists and makes it easily accessible for analysis. CODE’s report highlights opportunities for progress in adapting and applying Healthy People 2030 nationally and locally; more effectively coordinate SDOH work within and between federal agencies; set goals for progress in underrepresented areas, using an equity lens; and make SDOH data easier to access and use.

CODE is also continuing its work on SDOH with a focus on its application to racial equity. On April 6, CODE co-hosted a webinar to explore this topic and other applications of open government data for racial equity in healthcare, and featured speakers from government and the private sector.

Ultimately, federal government agencies share responsibility for protecting the health and well-being of Americans in the face of the COVID-19 pandemic, climate change, racial injustice, and economic inequality. The SDOH provides a framework to meet this challenge, building on the strong foundation that HHS has established. Federal agencies have the opportunity to work together, to collaborate with coalitions of actors outside of government, to set ambitious goals to improve the health of Americans and to achieve them.

Joel Gurin is president of the Center for Open Data Enterprise (CODE), where Matthew Rumsey is responsible for research and communications.


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