A national overview of nonprofit hospital community benefit programs to address the social determinants of health

Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) identified SDOH as a top-5 health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients, while the remaining 56% of programs addressed SDOH at the community level. Hospitals that were major teaching organizations, those in the Western region of the United States, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients. Social determinants of health (SDOH) refer to the “conditions in which people are born, grow, live, work, and age.” SDOH have an outsized effect on the health outcomes of individuals and communities, above and beyond formal medical care. For this reason, health care organizations such as hospitals are facing new requirements to screen patients for their individual health-related social needs and invest in improving SDOH in the communities where they are located. In this study, we investigated what approaches nonprofit hospitals use to address both patients’ health-related social needs and community-level SDOH, and present data from a national sample of 613 hospitals. We found that 44% of hospital programs addressed patients’ health-related social needs, while 56% addressed community-level SDOH, such as improving economic conditions or investing in local schools. The most common programs to address community-level SDOH were aimed at increasing social support and improving local infrastructure such as housing, parks, and transportation. Stronger policies and regulation may be necessary to encourage hospitals to invest in improving community-level SDOH above and beyond addressing individual patients’ health-related social needs.