SDoH’s Glaring Realities: The Nemours Children’s Health System Poll

The report is clear about accountability for action by providers.

I’ve been focused on the social determinants of health (SDoH) for all of my almost 40-year career in the healthcare industry, intervening across every domain and population, with traditional faces and also those new to the fold. As an industry subject matter expert, I’m informed on every nook and cranny of the topic. Many have heard me convey how on any given day, most health organizations and the populations they care for are impacted by at least one if not more of the five SDoH domains:

    1. Economic Stability
    2. Education
    3. Social & community context
    4. Health & health care
    5. Neighborhood & built environment

There has been no lack of data to affirm this fact, although a recent survey has heightened industry alert to the fiscal and human costs faced by today’s healthcare consumers. 

The online survey, titled Redefining Health for the Well-Being of Children, was conducted by Harris for Nemours Children’s Health System, a large provider of healthcare in the Mid-Atlantic region of the United States.

Major Survey Results
Some 1,017 U.S. parents of children under the age of 18 participated in this focused examination of the realities faced by systems’ healthcare consumers. The results are an important lens through which to view care disrupters faced by urban, suburban, and rural communities, crossing all the SDoH domains:

  • 32 percent of respondents were unable to pay one or more bills.
  • 32 percent had to skip a physician or dental appointment due to the inability to pay for the visit or find transportation to get there.
  • 30 percent have trouble paying for a physician/dentist appointment, getting to the appointment, or obtaining prescribed medication.
  • 23 percent are concerned they will run out of food.
  • 10 percent are unable to get to grocery stores with healthy food options.
  • 17 percent are fearful of personal safety in their community, whether for themselves or their family.
  • Another 17 percent were unable to find work or affordable child care.

Assessment for the SDoH and Overcoming Bias

The Dartmouth Study released this past fall yielded compelling validation about both provider and practitioner screening for the SDoH. It was disappointing to hear how few of these entities completed this vital task; about 24 percent of hospitals and 16 percent of physician practices reported screening for all five key social needs. That study makes the results of the Nemours survey even more pivotal to address:

  • Over 55 percent of parents reported that their healthcare provider or insurer had not questioned them about the SDoH.
  • Only 33 percent indicated that their healthcare provider or insurer asked them about the SDoH in the last year.

Given the prevalence of electronic record platforms that now incorporate SDoH assessment, these results are even more surprising. One of the first things I often hear from colleagues is a litany of complaints about their patients and families; I also often hear how infrequently the populations dealing with the SDoH actually follow up, or engage with referrals provided.

I understand how easy it can be to blame populations for not accessing care, although this stance is a bias that is not beneficial to the problem – or accurate. The Nemours survey provided a different perspective that must be acknowledged and addressed by the industry:

  • 68 percent of parents received social service referrals but were unable to obtain such services due to:
    • 33 percent: lengthy waiting lists of agencies
    • 32 percent: inability to pay for services
    • 27 percent: lack of transportation or other access-to-care challenges that impact care and follow-up

At the end of the day, two-thirds of those persons interviewed claimed that at least one SDoH limits their children’s ability to live a healthy life.

Nemours detailed a clear strategic plan to address the SDoH, moving forward. The report is clear about accountability for action by the providers, including but not limited to the following:

  • Expanding screening and assessment tools and processes to better hone in on those in need
  • Linking families to resources
  • Close coordination with insurers
  • Aggressive community efforts to define priorities and funding gaps, addressing both SDoH & SDoMH (social determinants of mental health)
  • Affirmed cross-sector collaboration
  • Advocacy, at local and national levels

Your Holiday Wish List to Address the SDoH
The Nemours survey raised an important question for consideration by all healthcare organizations. It served as the Monitor Monday Listeners Survey for this past week:

What should be on your organization’s holiday wish list to address the SDoH?

This particular survey had record numbers of our listeners weighing in, with surprising results worthy of sharing. I expect the responses will provide you guidance in prioritizing your SDoH Wish List for 2020!

Implement new screening and assessment tools/platforms


Enhance cross-sector partnerships to expand service/programs


Access grant funding for program development/service expansion


Expand dedicated staffing for population health initiatives



Follow this continuing story weekly on Monitor Mondays and the State of the Social Determinants report.


Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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