When people pursue health care, they are doing so because they expect that care to improve their health. But, rigorous research has reported that health care services determine only about 10 or 20 percent of health outcomes. The other 80 to 90 percent is determined by what we call “social determinants of health” (SDoH for short). These social determinants include health-related behaviors, socioeconomic factors, and environmental factors, which define the conditions in which people live, work, grow, and age. Economic policies, economics systems, social norms, social policies, and political systems have a great influence over SDoH. Some research has found that non-behavior-related SDoH account for 30-55% of health outcomes. This month, we highlight the research of IHPS scholars who are examining the impact of SDoH on health, behavior, and systems, as well as policies that might intervene to improve SDoH and, ultimately, increase health equity. This is an area of work that has roots at IHPS going back to our founding. Read on to be inspired and learn how we can advance better health for all.
Joanne Spetz
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IHPS Focus On:
Social and Environmental Determinants of Health
Many IHPS faculty are researching and working on policies related to the social and environmental determinants of health. Rita Hamad, MD, PhD focuses on the pathways linking social factors like poverty and education with racial and socioeconomic disparities in health. Hilary Seligman, MD, MAS reserches food insecurity and its health implications across the life course, including the impact of federal nutrition programs (particularly SNAP) and the charitable food network (including food banks, voucher programs, and medically tailored meal programs. Laura Gottlieb, MD explores health care sector programs and policies related to identifying and addressing social risk factors in the context of care delivery. Courtney Lyles, PhD is working with local community-based organizations (CBOs) in San Francisco on an open-source tool hosted in Salesforce for CBOs to support community leaders in their resource referral process to address social determinants of health. Stuart Gansky, MS, DrPH is leading the adoption and collection of a set of common data elements in social determinants of health, comorbidities, and self-rated health for the NIMHD Multiple Chronic Disease Disparities Research Consortium also known as the Health Equity Action Network . Dean Schillinger, MD, along with Hilary Seligman, Rita Hamad and Marianne Bitler, researches the health effects of addressing food insecurity through the federal nutrition programs SNAP and WIC.
Learn more about IHPS's current work to improve health and healthcare through addressing social and environmental determinants of health. Read more
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California Labor Lab Webinar Series |
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Sweated Labor: Gigwork, Essential Work, and the Wages of Service
Annie McClannhan, PhD
Professor of English, UC Irvine
Oct 26, 12 - 1 pm
Webinar registration link here
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Making an IMPACT: Science for the Real-World |
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Marion Nestle: The Journey of One Woman in Science and Policy
Marion Nestle
Paulette Goddard Professor of Nutrition, Food Studies and Public Health, Emerita at NYU
Reflections on the Status of Women at UCSF by: Catherine Reinis Lucey, MD, MACP, Executive Vice Dean and Vice Dean for Education, Professor of Medicine, UCSF School of Medicine
Nov 3, 3:30 - 5 pm (reception following)
Robertson Auditorium
Mission Bay Conference Center
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IHPS How to Impact Policy Webinar Series
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Developing and Maintaining Your
Policy Long Game
Patty Barahona, CEO, Youth Leadership Institute
Anthony Wright, Executive Director, Health Access
Tracey Woodruff, Professor, UCSF
Nov 9, 12 - 1 pm
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IHPS Health Policy Grand Rounds
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Rural Hospital Closures, Access to Care, & Care Utilization among Rural-Dwelling Adults
Arrianna Marie Planey, PhD MA
Assistant Professor, Department of Health Policy and Management, UNC Chapel Hill
Faculty Fellow, Cecil G. Sheps Center for Health Services Research
Nov 16, 12 - 1 pm
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IHPS National Advisory Board |
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Healthcare organizations are increasing social determinants of health (SDH) screening and documentation in the electronic health record (EHR). In a recent Journal of American Medical Informatics Association article, Bradley Iott, PhD, Matt Pantell, MD, MS, Julia Adler-Milstein, PhD and Laura Gottlieb, MD share their findings that can inform the design of promotion and training activities to maximize use of existing, available SDH capacities. The researchers leveraged national physician survey data to measure level of awareness and variation by physician, practice, and EHR characteristics to inform practice- and policy-based efforts to drive medical-social care integration.
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Fossil fuels are the primary source of petrochemicals, which are increasing in production volume. These chemicals are detected widely in maternal and child populations globally and are risk factors for multiple chronic diseases, many of which are increasing among pregnant women and children and aggravate health inequities, especially among these susceptible populations. In a recent International Journal of Obstetrics and Gynecology article
Tracey Woodruff, PhD, MPH and colleagues share that fossil fuels are a twin source of threats to global health through both climate change and hazardous chemical exposures, which will more adversely impact maternal and child health and exacerbate health inequities. Efforts to reduce fossil fuel use will mitigate exacerbations of maternal and child health inequities due to climate change, while also decreasing a source of chemical exposures, which could contribute to a double benefit to health.
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Screening and surveillance colonoscopies are essential diagnostic and treatment approaches for colorectal cancer, but access is inequitable. In a recent Annals of Surgery Open article, Margot Kushel, MD, Liza Wick, MD and colleagues use a case report to highlight structural barriers to guideline adherence for colorectal cancer surveillance in a homeless patient. They recommend specific policy action to address key barriers: facilitate FIT and FOBT use, restructure medical respite or provide hotel vouchers for private bathroom bowel preparation for high-risk patients, and fund patient navigator programs. Ultimately, comprehensive interventions aimed at creating stable permanent housing and wraparound healthcare services is key to addressing the multiple factors underlying this and other health care disparities for homeless patients.
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A healthcare workforce representative of the race/ethnicity composition of the population it serves is central to addressing systemic health inequities. In a recent Policy, Politics & Nursing Practice article, Ulrike Muench, RN, PhD, FAAN and colleagues shared their findings from an examination of the changes in the distribution of underrepresented minority (URM) nurses compared to non-URM nurses for several workforce characteristics, including clinician type, educational attainment, job type, rural/urban status, and unemployment over a period of 10 years. Their analysis of workforce trends of URM nurses found that the URM nursing workforce in 2018/2019 was still roughly 12 PPs shy of the 31% URM representation in the U.S. population. While their analysis cannot quantify the role of structural racism in the data observed, results across clinician roles, educational attainment, job types, and labor force participation showed that unequal educational and professional opportunities persisted over the last decade for many URM nurses, suggesting that racism continues to permeate through the ranks of the nursing profession.
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IHPS faculty are responding to policy challenges raised by the
COVID-19 pandemic with rapid-cycle research and technical assistance.
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Megha Garg is an Associate Professor of Medicine, Associate Chief of Hospital Medicine at the San Francisco VA Medical Center, and affiliated faculty at IHPS. Her clinical work includes attending on the inpatient teaching service, surgical co-management, and the Faculty Hospitalist Service. She is Director of the UCSF/UC Hastings Consortium on Law, Science, Health Policy,
She is an Associate Program Director of the Internal Medicine Residency Program, with a focus on residency curriculum and faculty development. Previously she was the course director for a first-year UCSF School of Medicine course titled “Health and the Individual/Health and Society,” focused on health equity, social justice and health systems science content, and helped the efforts of building an anti-oppression curriculum at the medical school. Her scholarly work includes research on physician advocacy, social justice education, and care of socially complex patients.
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Catherine Chen:
(UCSF News)
Kim Rhoads:
(The San Francisco Chronicle)
Joanne Spetz:
(CalMatters)
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