Examples of How the Social Determinants of Health Can Be Addressed Through the 10 Essential Public Health Services
Public health departments and their partners need to consider how conditions in the places where people are born, live, learn, work, play, worship, and age affect a wide range of health risks and outcomes. These social determinants of health (SDOH), and actions to address the resulting health inequities, can be incorporated throughout all aspects of public health work.
The 10 Essential Public Health Services (EPHS), updated in 2020 with equity at its center, is a well-recognized framework for carrying out the mission of public health and provides a framework within which SDOH can be addressed. The revised EPHS includes more attention to equity and multi-sector efforts so as to better align to current and future public health practice.
Interventions that modify SDOH are integral to advancing health equity. The examples below provide awareness of how the 10 EPHS can better incorporate consideration of SDOH and advance health equity.
EPHS 1: Assess and monitor population health status, factors that influence health, and community needs and assets
- Use measures of social and structural SDOH such as income, education, and employment to understand the root causes of health disparities and inequities in communities (measures and data available from sources such as County Health Rankings, PLACES, Compendium of Federal Datasets Addressing Health Disparities [PDF – 3.94 MB])
- Ensure community health assessments (CHAs) utilize SDOH measures and benchmarks drawing from national sources such as Healthy People 2030
- Engage communities and multi-sectoral partners in CHA efforts
EPHS 2: Investigate, diagnose, and address health problems and hazards affecting the population
- Include diverse sources of data and community-level determinants of health in investigations of public health issues
- Ensure multi-sector partner and community engagement in investigating and addressing health problems, soliciting input, and sharing information
- Consider needs for populations who may be at higher risk (e.g., people experiencing homelessness, older adults, people with disabilities) during emergency responses and work with partners, including emergency management agencies, to plan accordingly
EPHS 3: Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it
- Work with community groups to create and deliver effective, culturally and linguistically appropriate approaches, messages, and materials to help address SDOH
- Ensure the use of communication channels appropriate for the intended population including disseminating through multisector partners
- Ensure the use of best practices for clear, equitable, and accessible communication, employing principles of health literacy to inform the public
EPHS 4: Strengthen, support, and mobilize communities and partnerships to improve health
- Authentically engage with community groups and people with lived experiences to understand and develop solutions to help address SDOH and improve health
- Convene, facilitate, or engage in multisector partnerships and coalitions with partners such as housing, law enforcement, education, and transportation
EPHS 5: Create, champion, and implement policies, plans, and laws that impact health
- Champion, support, and leverage policies and laws that affect SDOH to implement policy initiatives that improve health outcomes, such as
- Tenant-Based housing voucher programs that can provide access to better housing and neighborhood opportunities
- Land reuse planning that can improve community health
- Develop and implement state/community health improvement plans that include and address the SDOH in collaboration with community partners
EPHS 6: Utilize legal and regulatory actions designed to improve and protect the public’s health
- Collaborate with multisectoral partners to ensure laws which impact SDOH are equitably applied in the community, such as housing eviction laws
- Develop strategies to ensure enforcement of regulations and laws which impact health, such as housing and health codes to prevent childhood lead poisoning or laws related to injury and violence prevention
EPHS 7: Assure an effective system that enables equitable access to the individual services and care needed to be healthy
- Connect eligible community members to health and social services such as
- Medicaid, including its medical, mental health, and housing benefits
- Temporary Assistance for Needy Families
- Supplemental Nutrition Assistance Program
- Ensure health services, including behavioral and mental health services, are culturally and linguistically appropriate
- Collaborate with multisector partners (e.g., transportation, housing) to address and remove barriers to care
EPHS 8: Build and support a diverse and skilled public health workforce
- Support staff training and development efforts that build health equity skills and teach cultural humility
- Incorporate responsibilities related to addressing SDOH into position descriptions and performance evaluations
- Build partnerships with academic institutions to strengthen links between learning about and the practice in addressing SDOH
EPHS 9: Improve and innovate public health functions through ongoing evaluation, research, and continuous quality improvement
- Use performance management and quality improvement methods to ensure services, policies, and plans effectively address SDOH and contribute to health
- Promote use of evidence-based practices to address health inequity and demonstrate improved health outcomes; examples include healthy school meals for all , year-round schooling, and tenant-based housing vouchers
- Establish and use community-based engagement and decision-making structures such as community-based participatory research designs or participatory budgeting [PDF – 269 KB]
EPHS 10: Build and maintain a strong organizational infrastructure for public health
- Actively engage governance bodies (e.g., board of health, health council) to understand and address SDOH in the community
- Conduct strategic planning and establish organizational health equity policies in ways that utilize health equity frameworks and public health ethics
- Establish robust information technology services that allow for collection and sharing of SDOH and health equity data
