In recent years, healthcare stakeholders have increasingly turned their attention to addressing social determinants of health (SDOH) as a means to improve health outcomes and reduce overall healthcare costs. SDOH refer to the non-medical factors that influence health outcomes, such as socioeconomic status, education, neighborhood and physical environment, employment, and social support networks. These factors can have a profound impact on an individual’s health, often surpassing the effects of clinical interventions alone.
Research has shown that SDOH can account for up to 80% of health outcomes, making them a critical area of focus for healthcare organizations aiming to improve population health and reduce costs. As a result, leading health insurers and healthcare providers have begun to invest directly in SDOH-related initiatives, such as creating referral networks for social services, building affordable housing, and establishing food pantries. These investments are essential steps toward addressing the root causes of health disparities, but they represent only one part of the equation.
The Role of Policy in Shaping SDOH
While direct investments in SDOH by healthcare organizations are crucial, they are not sufficient on their own to create lasting change. The broader social and economic structures that determine SDOH are largely shaped by policy decisions at the federal, state, and local levels. For example, policies that affect housing affordability, access to education, employment opportunities, and social safety nets all have significant implications for health outcomes. Therefore, to create systemic and sustainable improvements in SDOH, healthcare stakeholders must also engage in advocacy and lobbying efforts to influence policy.
Lobbying, in particular, offers a powerful tool for healthcare organizations to advocate for policy changes that can positively impact SDOH. By leveraging their influence, these organizations can help shape the policy environment in ways that promote health equity and address the upstream causes of poor health. However, despite the significant potential of lobbying as a strategy for addressing SDOH, there is evidence that healthcare organizations have not fully utilized this avenue.
Analyzing Healthcare Lobbying on SDOH: A Missed Opportunity
A review of federal lobbying disclosures from the ten highest-spending health insurance and healthcare provider organizations and related associations between 2015 and 2019 provides insight into the extent to which these organizations have lobbied on SDOH issues. The analysis focused on key SDOH issues defined by the Accountable Health Communities Model (AHCM) health-related social needs screening tool, including housing instability, food insecurity, transportation, financial strain, employment, education, and interpersonal safety.
The results of this review revealed that while some healthcare organizations reported lobbying on certain SDOH issues, such as financial strain, employment, food insecurity, and interpersonal safety, many other critical areas, such as housing, transportation, and education, were notably absent from their lobbying agendas. Specifically, five of the ten organizations reported lobbying on at least one SDOH issue, while the remaining five did not report any lobbying on these issues.
For example, the American Medical Association (AMA) lobbied on issues related to financial strain, such as the reduction of taxes on feminine hygiene products and interpersonal safety, including policies to address domestic violence. Similarly, some health insurance companies, such as Aetna and UnitedHealth Group, focused their lobbying efforts on employment-related issues, such as workplace diversity and hiring underserved populations. However, none of the organizations included in the study reported lobbying on housing instability, transportation, or education—despite the well-documented impact of these factors on health outcomes.
This lack of comprehensive lobbying on SDOH issues represents a missed opportunity for healthcare organizations to influence policy in ways that could significantly improve population health. Given the substantial resources these organizations dedicate to lobbying—over $507 million combined between 2015 and 2019—there is considerable potential for them to expand their efforts to address a broader range of SDOH issues through policy advocacy.
Corporate Incentives and the Case for SDOH Lobbying
To understand why healthcare organizations may not be fully leveraging their lobbying efforts to address SDOH, it is crucial to consider the incentives that drive corporate lobbying behavior. In general, corporations and associations engage in lobbying to advance their interests, which can include direct financial returns, reputational benefits, or alignment with the values of shareholders or members.
For healthcare organizations, the decision to lobby on SDOH issues may be influenced by several factors. First, there may be a perception that lobbying on these issues does not offer sufficient direct financial returns. For example, while investing in affordable housing or education policy may have long-term benefits for population health, the financial returns for healthcare organizations may be less immediate or less tangible compared to lobbying on issues that directly affect their bottom line, such as healthcare reimbursement rates or regulatory compliance.
Second, healthcare organizations may prioritize issues that are more directly related to their core competencies. For instance, organizations may feel more confident lobbying on healthcare-specific issues, such as Medicare and Medicaid policies, rather than on broader social issues like housing or transportation. It may be particularly true for for-profit organizations, which may be more focused on maximizing shareholder value and less inclined to engage in advocacy on issues that do not have an immediate impact on their financial performance.
Third, there may be a lack of awareness or alignment within healthcare organizations regarding the importance of SDOH. In some cases, the responsibility for addressing SDOH may be siloed within specific departments, such as community health or corporate social responsibility, without being integrated into the broader lobbying strategy of the organization. As a result, SDOH issues may not be prioritized in lobbying efforts, even though they are recognized as important determinants of health.
Despite these challenges, there is a strong case for healthcare organizations to expand their lobbying efforts to include a broader range of SDOH issues. First, the potential impact of policy changes on SDOH is substantial. For example, lobbying for policies that increase access to affordable housing, improve transportation infrastructure, or enhance educational opportunities could have far-reaching effects on population health and help to reduce health disparities. These changes could also lead to long-term cost savings for healthcare organizations by reducing the demand for medical services and improving overall health outcomes.
Second, lobbying on SDOH issues can enhance the reputational benefits of healthcare organizations. As public awareness of SDOH continues to grow, organizations that are seen as leaders in advocating for policies that address these issues may gain favorability among consumers, employees, and policymakers. It can translate into increased customer loyalty, improved employee satisfaction, and greater influence in the policy-making process.
Finally, addressing SDOH through lobbying aligns with the broader mission of many healthcare organizations to improve health and well-being in the communities they serve. By advocating for policies that address the root causes of health disparities, healthcare organizations can fulfill their commitment to promoting health equity and making a positive impact on society.
Recommendations for Expanding SDOH Lobbying
To maximize the impact of their SDOH strategies, healthcare organizations should consider several key actions to expand their lobbying efforts on these critical issues.
Integrate SDOH into Corporate Lobbying Agendas: Healthcare organizations should ensure that SDOH issues are integrated into their overall lobbying strategies. It may involve breaking down internal silos and fostering collaboration between departments responsible for community health, government affairs, and corporate social responsibility. By aligning their lobbying efforts with their broader mission to improve population health, organizations can more effectively advocate for policies that address SDOH.
Collaborate with Existing Advocacy Coalitions: Rather than lobbying on SDOH issues in isolation, healthcare organizations can amplify their impact by partnering with existing advocacy coalitions that are already working on these issues. For example, organizations could collaborate with affordable housing advocates, transportation reform groups, or education policy organizations to advance shared goals. This approach allows healthcare organizations to leverage the expertise and political connections of these coalitions while contributing their own resources and influence to the cause.
Leverage Contract Lobbyists for SDOH Advocacy: Healthcare organizations often employ contract lobbyists who have broad political connections and experience across a range of policy areas. These lobbyists can be directed to advocate for SDOH issues in addition to traditional healthcare-related topics. By expanding the scope of their lobbying efforts, healthcare organizations can increase their influence on SDOH policy and help shape a more favorable policy environment for health.
Increase Public Awareness of SDOH Issues: Healthcare organizations can also play a role in raising public awareness of the importance of SDOH. By producing thought leadership pieces, participating in public forums, and engaging with the media, organizations can help to build momentum for policy change on these critical issues. Increased public awareness can create pressure on policymakers to prioritize SDOH in their legislative agendas, making it more likely that meaningful policy changes will be enacted.
Advocate for Policies that Align Financial Incentives with SDOH: Finally, healthcare organizations should advocate for policy changes that better align financial incentives with the goal of improving SDOH. For example, payment models that reward healthcare providers for addressing SDOH, such as value-based care models, can create stronger financial incentives for organizations to invest in these areas. By supporting these types of policy changes, healthcare organizations can create a more favorable environment for SDOH-focused investments and lobbying.
The Future of Healthcare Lobbying on SDOH
Healthcare organizations have a unique opportunity to influence policy on social determinants of health and create lasting improvements in population health. While some organizations have begun to lobby on SDOH issues, there is significant untapped potential for expanding these efforts and making a greater impact. By integrating SDOH into their lobbying agendas, collaborating with advocacy coalitions, leveraging contract lobbyists, raising public awareness, and advocating for aligned financial incentives, healthcare organizations can help shape a more equitable and health-promoting policy environment.
As the healthcare sector continues to evolve, addressing SDOH through direct investments and policy advocacy will be essential for creating a more holistic and effective approach to improving health outcomes. The path forward involves continuing to support individual and community-level interventions, as well as pushing for systemic changes that can transform the conditions in which people live and work. By taking a more active role in lobbying for policies that address the root causes of health disparities, healthcare organizations can make a profound and lasting impact on the health and well-being of the populations they serve.
Investing in social determinants of health through lobbying is not just a moral imperative; it is also a strategic opportunity. The healthcare landscape is increasingly shifting towards value-based care, where the focus is on outcomes rather than services provided. In this context, addressing the social factors that contribute to poor health outcomes becomes crucial. Policies that promote access to safe housing, nutritious food, education, and employment opportunities can reduce the burden on the healthcare system by preventing the onset of chronic conditions and reducing the need for expensive medical interventions.
Moreover, by engaging in SDOH lobbying, healthcare organizations can position themselves as leaders in the movement toward health equity. This leadership can enhance their reputation, build stronger relationships with policymakers, and create a competitive advantage in an industry that is increasingly focused on social responsibility. As consumers, employees, and investors become more conscious of the social impact of businesses, healthcare organizations that are proactive in advocating for SDOH policies may find themselves better positioned to attract and retain talent, build customer loyalty, and secure funding.
The time is ripe for healthcare organizations to expand their lobbying efforts and fully embrace their role as advocates for social determinants of health. By doing so, they can help to create a healthier, more equitable society—one where everyone has the opportunity to achieve their full health potential, regardless of their social or economic circumstances. This is not just an investment in public health; it is an investment in the future of healthcare itself.
