Social determinants of health under the Trump administration—good as well as bad news

The first few weeks of the Trump administration fueled concerns that efforts to address the social determinants of health (SDOH) might stall. The SDOH include living conditions that influence household and public health (such as housing, food security, and transportation), but also include broader influences (such as racial segregation, Medicaid eligibility rules, and education).The Trump administration’s actions on broader influences (from generating anxiety in immigrant communities to non–fact-based edicts on vaccines and the causes of ill health) have been a huge setback for tackling SDOH. There were fears, too, that state and local progress on widely accepted factors (such as housing and nutrition) would be blocked by federal action. Indeed, shortly after Donald Trump took office, a federal playbook developed for states and localities to implement strategies for SDOH vanished from the White House website. In addition, the Centers for Medicare & Medicaid Services rescinded key guidance for the Medicaid 1115 waiver program, indicating that it would likely be an uphill battle for states to win federal approval for new SDOH initiatives within Medicaid.