New Focus in Community Health Needs Assessments: The Social Determinants of Health

Elderly people standing in a room doing exercises and following a person at the front of the room leading the exercises.

New Focus in Community Health Needs Assessments: The Social Determinants of Health

Community health needs assessments (CHNAs), commonly performed by hospitals and other institutions, identify and describe factors that affect a given area’s health. Lately, there’s been a shift: CHNAs increasingly focus on the social determinants of health. This is making the assessments more useful in setting priorities for action.

Until recently, most hospital-led CHNAs centered on clinical care needs. When CHNAs, for example, mentioned transportation, it was in the context of difficulties in getting to medical appointments or to programming, rather than in the context of transportation being a barrier to the community’s overall health. People were seen primarily as patients. This missed many aspects of peoples’ lives that affect health, such as access to healthy food, living-wage jobs, and again, transportation.

However, in 2019 more CHNAs in Greater Boston used a social-determinants-of-health lens to identify peoples’ needs. This means identifying economic, environmental, and social factors that affect a community’s health.

For instance, there were hospitals that discussed how housing quality and affordability can affect community health outcomes. Some even made capital and operational investments to address the social determinants identified in the CHNAs.

CHNAs and the Community Health Improvement Plans (CHIPs) that they feed into are required of hospitals every three years. In this round, some hospitals collaborated on their CHNAs. In doing so, the hospitals aimed to achieve deeper engagement with stakeholders, to enhance the alignment of the hospitals’ priorities and in the use of data, and to coordinate implementation strategies.

We are seeing this same level of effort and coordination occur as other organizations – health departments and non-profits – update their needs assessments. This bodes well for addressing the upstream factors that keep people healthy and well.

CHNAs are an important tool to inform and drive community development.

They can be a key resource for planner in Greater Boston by providing a health lens and understanding about how the economic, environmental and social factors impact people’s health outcomes.

A colorized photo of numerous attached homes in a row.
A child carries a grey bucket in his right hand as he walks across a large garden area.
Koi fish made out of construction netting, gloves, and air mask at Wake Up the Earth 2019