March 2022

In This Issue: HSR&D Research on Social Determinants
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Overview: HSR&D Research on Social Determinants

There is increased attention on social determinants of health (SDH) as a result of evidence showing that a patient’s social background is associated with their health behaviors and clinical outcomes, therefore, healthcare systems are being held accountable for addressing social factors. According to the US Department of Health and Human Services’ Office of Disease Prevention and Health Promotion, there are five domains of SDH:

• Economic stability, e.g., people with steady employment are less likely to live in poverty and more likely to be healthy.
• Education Access and Quality, e.g., people with higher levels of education are more likely to be healthier and live longer.
• Healthcare Access and Quality, e.g., strategies to increase insurance coverage rates are critical to providing preventive care and treatment for chronic illnesses.
• Neighborhood and Built Environment, e.g., racial/ethnic minorities and those with low incomes are more likely to live in places that pose risks, such as unsafe air or water and high rates of violence.
• Social and Community Context, e.g., positive relationships at home, at work, and in the community can help reduce the negative impacts of the environment.

HSR&D conducts an array of research on social determinants of health. In addition to numerous individual studies that cover topics from addressing SDH among Veterans living in rural settings to enhancing social support to improve outcomes for Veterans with PTSD, HSR&D funds several Centers of Innovation that focus on SDH issues. For example, HSR&D’s Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans focuses on, among other topics, homelessness and food insecurity – two issues critical to Veterans’ health and wellbeing. HSR&D’s Center for Health Equity Research & Promotion (CHERP) works to advance the quality and equity of health and health care for Veterans through health services research, research training and mentoring, service, partnerships, and stakeholder engagement.

In addition, VA’s Quality Enhancement Research Initiative (QUERI) supports several centers and projects that focus on SDH factors such as homelessness, criminal justice, and Veterans living in under-resourced areas. For example, BRIDGE-QUERI is working to implement three effective practices: Homeless Overdose Prevention Expansion; Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice; and Post-Incarceration Engagement. SERVE QUERI is assessing the effectiveness of the Social Work PACT (patient-aligned care teams) Staffing Program and will design tools to support this model. VA social workers assess all social determinants of health, deciding where Veterans need help and how it can most effectively be provided.