Health systems and social services— A bridge too far?

This JAMA Forum argues that hospitals and health systems should not take the lead in programs to address social determinants of health and provides examples and reasons why.

The health systems dedicated $2.5 billion of funding to these programs, of which about two-thirds was specifically committed to housing-focused interventions (other focus areas included employment, education, food security, and transportation). In short, health systems are making sizable investments in the social determinants of health. Proponents argue that these investments are needed not only because of the evidence on the health effects cited above, but also because community-based social service agencies and state social welfare systems are typically inadequately funded to address social needs.

We disagree. Health systems and hospitals should tread warily into the provision of social services and policymakers should not encourage this approach. It has real risks, such as diverting scarce resources to socially less-desirable uses, and few prospects of success. Social determinants of health should be addressed by the social service organizations and governments that specialize in this work. There are fundamental mismatches between the priorities and capabilities of hospitals and health systems and the task of addressing social determinants of health.