Clinical to Community Connections

Cross-Sector Partnerships to Address Social Determinants of Health

Social determinants of health are the conditions in the environments in which 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. Public health’s focus on population-level interventions, disease prevention, and health metrics can provide leadership and expertise in addressing the social determinants of health, but public health cannot address social determinants of health alone. Factors such as housing, education, socioeconomic status, employment, and access to care can only be improved through collaboration with partners in other state, local, and federal agencies, and with private sector partners as well.

States and localities are already pioneering innovative ways to coordinate initiatives across agencies and with other community partners to create the conditions people need to live happy, healthy lives. These include financial incentives in Medicare and state Medicaid programs, supportive housing, and linkages with social services such as employment counseling. ASTHO has compiled a number of examples below that illustrate a selection of these efforts and public health’s role in them.

Behavioral Health Partnerships

ASTHO, in partnership with NACCHO and the Practical Playbook and with support from HRSA, conducted a nationwide environmental scan to investigate how healthcare delivery systems are partnering with community-based organizations on behavioral health issues. This resource includes a chart of state-by-state results (as of fall 2018) and a summary of early findings.

Braiding and Layering Funding to Address Housing

The intersections of social determinants of health (SDOH) and their impact on the health of individuals and communities has been well documented. Research has found that stable, affordable, and accessible housing has a direct impact on physical and mental health outcomes, but with many public and private stakeholders involved, there are challenges for state and territorial health agencies to establish partnerships and obtain funding to address SDOH such as housing. Braiding and layering funding is one approach to addressing these complex issues. Many states already use innovative approaches to funding initiatives, and these white papers aim to help state and territorial health agency staff understand the process of braiding and layering funds to support housing:

ASTHO created these white papers in collaboration with experts from the O’Neill Institute for National and Global Health Law, with input from state and territorial health agency leaders, federal partners, and internal subject matter experts. The development of this document was supported by the Center for State, for State, Tribal, Local, and Territorial Support (CSTLTS) at the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) through the cooperative agreement CDC-RFA-OT18-1802.

Cross-Sector Partnerships to Improve Health and Housing Outcomes

ASTHO, CDC, and the U.S. Department of Housing and Urban Development convened public, private, and nonprofit leaders to share their insights on how to improve health and housing outcomes. Individual participants described their work and experiences in cross-sector partnerships, mechanisms for funding and financing, as well as data sharing. The convening, which was held November 29-30, 2016, sought to improve understanding of the reasons why these approaches have been successful in the context of the communities where they were implemented. This document provides a summary of the information that was presented and shared at the convening as a resource for individuals and organizations.

Health Impact in Five Years (HI-5)

The Health Impact in Five Years (HI-5) Initiative is a tool developed by the CDC that highlights non-clinical, community-wide interventions that have demonstrated improved health within five years or less, as well as reported cost effectiveness and/or cost savings over the lifetime of the population of earlier. Strong cross-sector partnerships between public health agencies and other organizations are important to successfully implementing each of the fourteen highlighted evidence-based interventions. Featured resources include:

How Housing Influences Health

ASTHO, with support from CDC, hosted a learning community with state health agencies to explore how public health can effectively partner with cross-sector partners to improve housing and transportation. This slide deck summarizes content from the discussion with states and explains why housing is a critical component of health and what the potential role is for public health.

Strengthening Community-Clinical Linkages to Improve Health Outcomes - Meeting Summary

The Association of State and Territorial Health Officials (ASTHO), funded by the Centers for Disease Control and Prevention (CDC), convened public, private, and nonprofit leaders in March 2019. These leaders shared examples with each other of collaborations between healthcare and community-based organizations that address health-related social needs. Convening attendees shared with one another specific strategies related to partnership-building, data-sharing, and sustainability, which ASTHO has referred to as the essential elements of effective community-clinical linkages.

White Paper: Creating a Transformed Health System in the 21st Century

ASTHO envisions a health system of the 21st century that integrates public health, clinical care, social services, behavioral health, and other stakeholders to comprehensively address the root causes of poor health, ranging from lack of exercise, poor diet, lack of access to care, and other factors. Most determinants of our health affect us outside of doctors’ offices, which means the health sector in the future must work together closely to improve health and reduce costs. The white paper outlines ASTHO’s vision for an integrated health system in the future, and steps that can be taken today to achieve it.