North Carolina Academic health centers and social determinants of health

BACKGROUND: Academic health centers (AHCs) have traditionally focused on 3 core missions: patient care, research, and education. The current changing health care environment requires AHCs to broaden their focus to improve the health of their communities. This study reports the opportunities and challenges for the 5 North Carolina AHCs addressing social determinants of health (SDOH). 

METHODS: We used a mixed methods design. We analyzed financial data from systemwide community benefits reports and the Form 990 Schedule H of the primary medical centers (when available) from the 5 AHCs, and we conducted 4 key informant (KI) interviews at each of the 5 AHCs for a total of 20 interviews. 

RESULTS: Overall, AHCs spend a very small percentage of their total spending on community improvement services and community benefit operations. By far, the largest amount spent on community benefit is for treating patients eligible for charity care. Food insecurity and access to health care were the most addressed SDOH. Housing was viewed as a crisis that needed to be addressed at statewide and national levels. 

LIMITATIONS: Community benefits reports from North Carolina AHCs lack important details. Key informant interviews provide far more recent information on the quantity and breadth of initiatives than the latest community benefits reports that were all completed pre-pandemic. We only interviewed 4 stakeholders from each AHC in North Carolina. 

CONCLUSION: A new strategic vision must incorporate social accountability into the AHCs' core missions to remove barriers and institute and sustain change, but the AHCs face a steep challenge to incorporate social accountability at a core mission level.