It is becoming cliché to say that “your zip code matters more than your genetic code,” and maybe that’s a good thing. The American medical community is beginning to acknowledge that health status is impacted by far more than genetics and what happens within the four walls of a doctor’s office. In fact, health care (10%) and genetics (30%) make up only 40% of the factors contributing to risk for premature death. In contrast, social issues, environmental exposures, and behavior patterns (which are often determined by social issues and environmental exposures) make up 60% of the risk factors for premature death [1].

Social, environmental, and behavioral factors impacting health are now described as the social determinants of health (SDOH). They include access to affordable and safe housing, transportation, and healthy foods. The graphic above, created by the Kaiser Family Foundation, depicts the broad range of social determinants that impact health outcomes.

A recent survey of physicians found that a majority believe that assistance addressing SDOH would help their patients [2]. It’s a great sign that most clinicians see the importance of addressing these needs. The study also points to the challenge of determining who has the responsibility to do so, with a majority of physicians saying it is not their responsibility to help patients address social needs. Given the limited time physicians have with their patients, their reluctance to take on this responsibility makes sense.

Yet, many physicians are working with other professionals in their practice, such as care managers and social workers, to screen patients for SDOH and connect them to resources in the community. Some health systems have implemented referral mechanisms to connect patients with community-based organizations (CBOs) like food pantries, housing authorities, and job training programs.

These efforts are at the heart of a growing concept called Accountable Care Communities (ACCs) (also known as Accountable Communities for Health, Accountable Health Communities, and other names). ACCs are coalitions of cross-sector stakeholders, including health care providers and community agencies that work together to improve health in a community. ACCs integrate health care, public health, education, and social services to address multiple determinants of health, including social determinants. The development of these models is happening alongside the transition to value-based payment systems that put a focus on patient outcomes rather than the amount of health care services provided.

The North Carolina Institute of Medicine has been convening a Task Force of stakeholders from around the state to make recommendations for state and local policies to support the development of ACCs. The Task Force will also produce a guide for communities interested in developing an ACC model, with helpful information and resources on topics like partnership development, financing mechanisms, and legal considerations.

While still in its infancy in North Carolina, the ACC concept is a hopeful sign of the move toward a more wholistic approach to health care that acknowledges and addresses social needs.

[1] Schroeder, SA. We can do better – Improving the health of the American people. New England Journal of Medicine. 2007. 357:1221-8.

[2] Winfiled, L, DeSalvo, K, Muhlestein, D. Social determinants matter, but who is responsible? Leavitt Partners. May 2018. https://leavittpartners.com/whitepaper/social-determinants-matter-but-who-is-responsible/