Social Determinants of Health: How to Build Them Into Your CHNA
Clinical care explains less of a community’s health outcomes than most people assume. Housing, transportation, food access, education, and economic stability all shape health just as directly. A CHNA that doesn’t account for these factors is only telling part of the story.
What counts as a social determinant of health
Social determinants of health, often shortened to SDOH, are the conditions in the places where people live, work, and go to school that affect health outcomes. The most commonly tracked categories include:
- Economic stability, including income, employment, and poverty level
- Education access and quality, including literacy and early childhood education
- Healthcare access and quality, including insurance coverage and provider availability
- Neighborhood and built environment, including housing quality, transportation, and safety
- Social and community context, including social support, discrimination, and community engagement
Why they belong in a CHNA, not just a clinical needs list
A CHNA that only asks about disease prevalence and healthcare access will surface real needs, but it will miss why those needs exist in the first place. A community with high rates of missed appointments might have a transportation problem, not an engagement problem. A community with poor chronic disease management might have a food access problem, not a compliance problem. SDOH data helps connect the clinical picture to its root causes, which changes what the eventual implementation strategy actually looks like.
How to build SDOH into the assessment process
Ask about it directly in primary data collection. Survey and interview questions should go beyond symptoms and diagnoses to ask about housing stability, transportation access, food security, and financial strain. Secondary data sources rarely capture this at the level of detail a direct question does.
Pull in place-based secondary data. Tools like the CDC’s Social Vulnerability Index and county-level housing and transportation data can validate and add context to what primary data collection surfaces.
Involve organizations that see these issues firsthand. Housing authorities, food banks, transportation agencies, and school districts often have a clearer real-time picture of SDOH-related barriers than clinical data alone would suggest. Bringing them into the input-gathering process, beyond the required public health department and underserved population representatives, adds depth the IRS requirements alone won’t guarantee.
Reflect SDOH findings in the prioritization, not just the appendix. If transportation or housing surfaces as a significant barrier, it should be treated as a significant health need in its own right, not a footnote under a clinical category it happens to affect.
What this looks like in an implementation strategy
A hospital that identifies a transportation barrier through its CHNA might partner with a local transit authority or fund a shuttle program, rather than only expanding clinical hours. A hospital that identifies food insecurity might build a food pharmacy or partner with a regional food bank. The action taken should trace directly back to the specific barrier identified, not default to a generic clinical response.