The coronavirus (COVID-19) pandemic shines a harsh and unforgiving spotlight on the impacts of the social determinants of health. New data from the U.S. Centers for Disease Control and Prevention (CDC) shows that people who are homeless or in congregate living facilities face additional challenges that can exacerbate the spread and severity of COVID-19. CDC data also indicates that the majority of people who are hospitalized for COVID-19 have an underlying condition such as hypertension, obesity, chronic lung disease, diabetes, and cardiovascular disease, many of which are linked to food insecurity. Worsening structural barriers, such as limited access to transportation, are making it even more difficult for patients to receive timely care.
It is unsurprising then that analyses at federal and state levels are showing a disproportionate burden of illness and death among racial and ethnic minorities.
“Health differences between racial and ethnic groups are often due to economic and social conditions that are more common among some racial and ethnic minorities than whites. In public health emergencies, these conditions can also isolate people from the resources they need to prepare for and respond to outbreaks.” – CDC, COVID-19 in Racial and Ethnic Minority Groups
In the midst of this, Rep. Nanette Diaz Barragán (CA-44) of the U.S. House of Representatives has introduced a bill that would, over time, propel federal and state governments to play a bigger role in addressing these issues: The Improving Social Determinants of Health Act of 2020 (H.R.6561).
Importantly, while the pandemic highlights the importance of the bill, H.R.6561 is not an emergency relief measure; rather, H.R.6561 focuses on longer-term progress. At its core, the Act would require the CDC to:
– create and award grants to state, local, territorial, or Tribal health agencies, or certain qualifying nonprofit organizations (eligibility for which is not defined by the Act) to address social determinants of health in target communities;
– create and award grants to nonprofit organizations and institutions of higher education to research, support, and disseminate best practices;
– coordinate across the CDC to ensure that various programs consider and incorporate SDOH in grant awards and other activities;
– coordinate, support, and align CDC activities related to SDOH with those of other federal agencies; and
– collect and analyze data related to SDOH.
Under the current language of the bill, $50,000,000 would be appropriated annually for 2021 through 2026, with the requirement that no less than 75% of funding each year goes towards grants.
H.R.6561 is somewhat unique because of its emphasis on leveraging the CDC and public health departments—on using public health departments to identify priorities in communities, coordinate collaboration across stakeholders, and advance policy reform relating to SDOH. Many of the federal government’s initiatives in this space have to date been driven by the Centers for Medicare & Medicaid Services (CMS). Similarly, the Social Determinants of Health Accelerator Act of 2019 (H.R.4004 and S.2986) (Accelerator Act), which was introduced last year and is still sitting in committees, would be driven primarily by CMS and focuses more specifically on supporting interventions in state Medicaid programs. H.R.6561 could therefore provide a valuable opportunity to complement more downstream, health care focused efforts such as the Accelerator Act, with funding for public health departments to address upstream community level needs.
Unfortunately, H.R.6561 is vague regarding the role of organizations across the country that are already on the ground addressing SDOH. While the bill contemplates that awards for programming could be provided to nonprofits, the parameters to this flexibility would be developed by the CDC after enactment. These details matter. Consider, for example, the implications for a community in which the relevant government officials are not SDOH champion. Without the right pathways for nonprofits to secure awards, that community would be locked out of this opportunity. As we see playing out right now, community-based organizations on the front line cannot be an afterthought.
While we haven’t heard much of the Accelerator Act since its introduction last year, it is possible that the current public health emergency will serve as a rude awakening. H.R.6561 could renew momentum for Congress to get to work planning for a better, more sound, and more resilient future. Those interested can learn about (and even sign on to support) the Improving Social Determinants of Health Act here.