The 2022 AcademyHealth Annual Research Meeting (ARM) offered a range of compelling topics, exploring critical and emerging issues in health services research related to the social determinants of health (SDOH) and addressing systemic racism to advance health equity.

Identified by the U.S. Department of Health and Human Services (HHS) as a priority area, social determinants of health are defined as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The focus on SDOH motivates researchers to discover and evaluate new approaches for mitigating the conditions that lead to disparate health outcomes. Although momentum around efforts to identify and address conditions and disparities has increased in recent years, alongside important conversations on health equity tourism, challenges remain in terms of readily accessible data.

Improving Accessibility and the Use of SDOH Data

SDOH learnings shared at ARM included the session, “Enhancing Accessibility of Federal and Community Level Social Determinants of Health Data” where Dr. Patricia Keenan began by reviewing a new AHRQ community-level SDOH database. The database will provide better access to documented, linkable SDOH variables collected across multiple sources and assist in informing SDOH research to identify effective interventions tailored to the populations served. Dr. Arlene Bierman presented on developing a comprehensive, patient-centered electronic care plan which incorporates SDOH. Regarding work on prioritizing data elements for development and inclusion, she noted the challenges with the substantial variation in how SDOH—such as education, food insecurity, and homelessness—are defined, as found in a scoping review of 27 studies exploring associations with increased risk of COVID-19 infection and outcomes.

Dr. Rachel Singer spoke on the importance of maintaining a person-centered orientation and holistic understanding of the complexity of individual social needs when the health sector enters the realm of SDOH-related community resource referrals. This approach can speak to specific community needs and local culture, building trust to facilitate improvements in individual and community health. Along those lines, DeWana Hadder, Director of United Community for Metro United Way, described her nonprofit organization’s use of the United Community platform which hosts a network of services, the majority being community-based organizations. The technological infrastructure, representation of sectors across health, education, and human services, and community-level data dashboard facilitate efforts such as predictive analytics for determining where to allocate services and resources as a community to mitigate needs.

This work is part of a portfolio of projects across an array of federal agencies working to advance data infrastructure for conducting patient-centered outcomes research related to key U.S. Department of Health and Human Services’ policy priorities. Learn more about the portfolio here.

Health Equity Snapshots: LTSS and Culturally Responsive Research Methods

“When we are talking about inequities, we are really talking about things that are changeable, things that are unfair, unjust,” Dr. Shekinah Fashaw-Walters said, “And that means that we have the power to shift these things.”

The session, “Addressing Systemic Racism across Long-Term Services and Supports (LTSS) to Advance Health Equity,” guided by the recently published paper on JAMDA, emphasized the need to acknowledge racism as a fundamental cause of LTSS inequities. Panelists highlighted the importance of diversifying LTSS, increasing Medicaid reimbursement, increasing the promotion of integrated care, and implementing effective support systems for Black, Indigenous, and other older adults of color. They further raised how policies must consider historic structures, such as racially segregated care, that exist within the long-term care system in order to advance health equity and dismantle structural racism.

Similar sentiments were echoed in a session on culturally responsive research methods, which began by Dr. Jameta Barlow acknowledging the ancestral lands of the Nacotchtank people and naming settler colonialism as a SDOH. Non-exhaustive discussion topics included the value of qualitative and mixed methods to provide greater context, and community engagement and co-creation in research. They further raised the internal work required of researchers regarding their own positionality and identity, which influences their experiences and understanding of the world. Intentional, culturally responsive research entails unlearning harmful assumptions on how research is done and seeking methodologies as to not replicate oppressive practices, for instance, attributing health effects to a false notion of biological race rather than racism and racialization.

Many of these takeaways echoed the words of Drs. Rachel R. Hardeman and J’Mag Karbeah in their examination of racism in HSR through a disciplinary self-critique in 2020, which included a call for interrogating how root causes, such as racism and white supremacy, shape SDOH.

Intersectionality in Health Services Research

Underlying these sessions—if not outright named—was the theoretical framework of intersectionality. Coined in 1989 by Dr. Kimberlé Crenshaw when centering Black women, intersectionality refers to how different dimensions of inequities operate and exacerbate each other, such as racism, sexism, classism, ableism, xenophobia, ageism, and the marginalization of LGBTQ+ people.

Intersectionality illuminates those who otherwise might be excluded from research and policy due to a limited, single-issue focus that risks hegemonic generalizations rather than addressing a range of lived experiences, power dynamics, and health outcomes. While there is still much work to be done, ARM 2022 showcased dedicated scholars and community members alike engaged in elevating SDOH, advancing health equity, and magnifying the overall impact of health services research.

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Sarah Weinberg

Research Assistant - AcademyHealth

Sarah Weinberg is a Research Assistant at AcademyHealth, where she supports the Clinical Decision Support Inno... Read Bio

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