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Network for Public Health Law

Social Determinants of Health Legislation: Opportunities for a New Future

May 5, 2021

Overview

On January 31, 2020, COVID-19 was declared a national public health emergency (PHE), freeing additional funds, resources, and personnel to respond to the crisis across the United States. Unfortunately, by the time of the declaration, it was already too late. The inaction that resulted in nearly 32 million cases and 570,000 lives lost to COVID-19 in the U.S. pre-dated the declaration of the PHE, not by days or months, but by decades. We find ourselves in this national crisis due to underfunding the public health infrastructure and our unwillingness to address the social, environmental, and economic influences that affect individual, community, and population health – known as social determinants of health (SDOH).

The public health infrastructure serves to prevent disease, promote health, and prepare for and respond to acute and chronic threats to health. Yet, experts estimate that it is operating with a $4.5 billion annual funding deficit. This means that comprehensive public health systems are available to only 51 percent of U.S. residents. Since the 2008 recession, public health funding has drastically decreased, impairing the ability of the public health infrastructure to modernize and address emerging threats. When adjusting for inflation, current funding for the Centers for Disease Control and Prevention (CDC) is just below its fiscal year 2008 funding. Since 2010, funding for both local and state health departments has decreased by 16 and 18 percent per capita, respectively. Due in part to this extreme underfunding of the public health infrastructure, vital public health services are incapable of addressing our chronic disease and opioid epidemics, as well as social, environmental, and economic risk factors that inform health inequities.

Since as early as 2008, we have known the integral role SDOHs play in health outcomes. However, it was not until 2020 that Congress acknowledged public health’s important role in “working across sectors on social determinants of health” and funded an SDOH pilot program. Taking language from the Social Determinants Accelerator Act of 2019, the SDOH pilot program was appropriated $3 million through the December 2020 omnibus bill to support the development of SDOH Accelerator Plans to address health and social outcomes for specified target populations. Grant applications to participate in the SDOH pilot program are not yet available but are expected to be released in the coming weeks.

Although we have taken a step in the right direction by funding the SDOH pilot program, it is still not enough. Like almost all public health crises, COVID-19 and our inadequate response have placed a harsh light on the public health infrastructure and values of our nation, as well as on those endemic health inequities that plague our low-income, underserved, and marginalized communities. Therefore, we must support policies and legislation that directly address the SDOHs and fortify the public health infrastructure. A recent example of such legislation is the Improving Social Determinants of Health Act of 2021 (H.R.379), reintroduced in the House of Representatives on January 21, 2021, by Congresswoman Nanette Diaz Barragán (D-CA-44).

The SDOH Act of 2021 proposes establishing a Social Determinants of Health Program to be carried out by the Director of the CDC. The two primary goals of the SDOH Program are to:

  1.  Improve health outcomes and reduce health inequities through the coordination of SDOH activities across the CDC.
  2.  Improve public health agencies’ and community organizations’ capacity to address SDOHs in communities.

To achieve the goals of the Program, the following activities are proposed for the Director to carry out:

  1. Ensure that CDC programs consider and incorporate SDOHs in grant awards and other activities.
  2. Award grants to local, State, territorial, and Tribal health agencies and organizations, and other eligible entities, to address SDOHs in target communities.
  3. Award grants to nonprofit organizations and public or nonprofit institutions of higher education to conduct research on best practices; provide technical assistance, training, and evaluation assistance; and share best practices with grantees.
  4. Coordinate, support, and align CDC SDOH activities with other Federal agencies (e.g., HHS and CMS).
  5. Collect and analyze data related to SDOHs.

The bill, as written, proposes that $50 million be appropriated to fund the Program. Conversely, President Biden’s FY2022 Discretionary Request details that $153 million should be appropriated for the Program. Appropriating $153 million to the Program would better build on efforts to “advance equity and reduce health disparities” than the $50 million requested in the SDOH Act.  

Through the passing of legislation that explicitly targets the SDOHs and increases the capacity of public health, we have an opportunity to change our trajectory from a “new normal” defined by health inequities aggravated by COVID-19 to one defined by their amelioration – a “new future.”

This post was written by Zamir M. Brown, Health Policy Fellow, National Health Law Program.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.