Collecting and Applying Data on Social Determinants of Health in Health Care Settings

The Issue:

Current approaches to social determinants are usually focused on population-level and policy interventions, ignoring the individual and clinical innovations that can address a patient’s social circumstances. This article discusses how the health care system can work to address social determinants and improve patient health on three levels—patient, institution, and community levels.

Key Findings

  • The authors suggest improving social data collection within clinical settings to track over time a patient’s social circumstances, and how their health is impacted.

  • Health care organizations should work to use social needs data to understand individual disease risk.

  • Locating health and social services in the same location can improve program efficiencies. Tools such as electronic health records can improve referral capacity.


As the Affordable Care Act is implemented, it is imperative that health care organizations address social factors at both individual and institutional levels.

About the Study:

This article proposes a framework for integrating determinants into the health care system. Defining three tiers, the article offers ideas on data collection and target interventions within the author’s proposed concept map.