September Newsletter

The leaves are just starting to fall…


Welcome to my September 2021 Living Conditions and Health newsletter. You can find past newsletters with additional background materials, and different stories and initiatives on my website and in my LinkedIn articles or posts. Join me in identifying and coordinating initiatives that advance health, health equity and community and healthcare redesign.

Shannah’s Insights and Reflections

The Biden Administration has gone all in on requiring vaccines.  The 6-part plan announced on September 9th is designed to facilitate vaccines in…” about 100 million Americans, or two thirds of the workforce.” This New York Times article gives an overview of the plan.  At the same time challenges with vaccine uptake have entrenched drivers including living conditions, health care access disparities and distrust, as discussed in a recent article from the Guardian.

I included coverage in the past newsletter on sustained structural racism in the form of poor housing and housing options for neighborhoods and purchase options that are predominantly targeting people of color. This recent article on locating a freeway in South Carolina that largely displaces black and brown people at the rate of 94% compared to whites is another too common occurrence that persists to this day. We need to be tracking all of these activities and reporting on them until policies and actions start to change. This practice should be illegal and is a vicious cycle that undermines sustainable black and brown communities.

Urban institute published a paper on how the Federal government can eliminate exclusionary zoning another mechanism used to constrain where people of color live and grow. The paper highlights how exclusionary zoning and fiscal pressures created and sustain limited affordable housing. This has been coupled by federal reticence to regulate and enforce requirements to improve equitable state and local land use. Governing land use is considered a fundamental responsibility of state and local governments. The pandemic however, magnified the inequities and inadequacy of affordable housing in all states. The paper concludes with recommendations on how to incentivize, …”by requiring states to identify clear and actionable goals for boosting affordable housing supply and lifting exclusionary barriers when they apply for competitive grants for housing, transportation, and infrastructure.” This would use broader program and funding levers than have been used in the past. It goes on to say the Feds should ask states to “set equitable and achievable performance goals” and show concrete steps through adoption of policies “aimed at lifting exclusionary barriers” to achieve the goals. The paper goes on to talk about progressive state policies that other states could be encouraged to adopt and the advantages and risks of the approach.

The Black Community Innovation Coalition made up of many large employers including Walmart, and Best Buy are teaming up with Grand Rounds health and Doctor on demand to build a care concierge and navigation platform for Black patients. The primary focus is on improving healthcare access. The goal is to launch the platform in early 2022.

The Pritzker administration in Illinois is investing $18M in enhanced support for services in rural IL. Living conditions in rural areas, in combination with greater barriers to healthcare access, warrant different solutions and alternative means of engagement. Read here about some of the innovations they are funding. I have regularly heard that healthcare stakeholders in rural communities are often more open to collaboration because they all struggle with scarcer resources and an understanding that no one organization can address the health and social needs of their patients, members, or constituents. The range of initiatives seem to reinforce this observation.

Technology and Data Standards

We are seeing continued efforts to standardize and improve social determinants of health (SDOH) data collection and sharing. This month the Office of the National Coordinator’s asked Health IT developers to add SDOH as a core feature and DirectTrust  launched a consensus body to advance SDOH Data exchange Interoperability. The desire to standardize and increase exchange is understandable, but perhaps these efforts need to step back and consider the recent findings on the 2020 census reported by NPR that 1 in 7 people indicated “some other race”. The issues that underlie health disparities and those that sustain racism will not be addressed if the information requested from individuals doesn’t reflect how they see themselves in the world. Additionally, too many, if not all of these efforts are missing two critical stakeholders: the individuals and the communities they are seeking to accurately represent and then support.

Health IT companies are offering solutions for refugees – a recent article talks about global and US efforts to help refugees use technology. There are many potential barriers including lack of access to technology, but volunteers in combinations with generous tech companies and communities can make a substantial difference in refugees’ abilities to access needed services. There are perhaps more unknowns than knowns about how broad the technology assistance will be. Let’s hope the emerging solutions are grounded in what we’ve learned in connecting individuals and families to needed health and community resources and that they are not limited to refugees if individuals and families living in the US are still struggling with the same needs.

Is consolidation in the SDOH analytics, services networks, and tech platform markets further evidence of a maturing market? Unite US acquired Now Pow after acquiring Carrot Health, characterizing the combined services as the leading integrated health and social care network. This follows the WellSky purchase of Healthify this past Summer.

SIREN picks

My last newsletter highlighted SIREN’s newsletters as a great resource, particularly for studies, articles, activities and events relating to research and evaluation of social interventions. My picks for SIREN’s September’s newsletter are: the issue brief and commentary on medical respite care for people who are homeless and the Medicaid and Health-Related Social Needs commentary from Center for Health Care Strategies .The homelessness medical respite will likely yield cost-saving in the long run, “it’s value more importantly can be measured in lives extended and improved.” The Medicaid commentary has four areas of lessons learned from working with states for four years that recognizes the distinct roles that states, plans and communities should play.

The Future of SDOH?

Several articles this month asserted incorporating SDOH as part of health services will or should be standard care in this decade. I hope they are right, but I doubt such a fundamental transformation will happen so quickly.


The Alliance for Health Policy held a health equity summit on September 15-16. The recordings are available here. I found the second session “towards better Health for All: Hearing from Underrepresented Voices in the Health Equity Dialogue a testament to the need for broader stakeholder inclusion in all of our equity endeavors.

I had the opportunity to participate in a roundtable discussion on cross-sectoral collaboration on SDOH hosted by the Department of Health and Human Services and the Center for Open Data Enterprise. Prior to the round table they held a webinar and provided a white paper as context for setting targets to improve SDOH across 7 factors…” that have a major impact on health and well-being: Housing, employment and economic stability, education, healthcare access, food security, transportation, and environment.” You can find the paper and public webinar here, under the heading CODE’s Health Data Roundtables when you scroll down the page.

During the roundtable, I learned about the Coordinating Council on Access and Mobility (CCAM), part of the Federal Transit Administration, initiative from 2019 that is an example of problem and perhaps part of the solution regarding support for equitable access to transportation. They developed an inventory of 130 Federal programs that are able to provide funding for human services transportation for people with disabilities, older adults, and/or individuals of low income. This could be a little known resource that might help many communities.

The Root Cause Coalition National Summit on Social Determinants of Health is being held virtually October 4-6.

Background and Definition

I have chosen the phrase “Living Conditions” rather than social determinants of health (SDOH) to make the concept more accessible.  This focus tracks with the Centers for Disease Control and Prevention’s SDOH definition “as conditions in the environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”

Go here for more information from CDC on its organizing SDOH framework in Healthy People 2020