Latest News A Response to the White House Playbook on SDOH
The White House backyard covered in snow - symbolizing policy discussions on Health Equity Playbook
December 20, 2023
A Response to the White House Playbook on SDOH

Last month, the White House took a pivotal step towards advancing health equity with the release of The U.S. Playbook to Address Social Determinants of Health. It’s a promising step towards improving the well-being of low-income communities and reducing the multigenerational impacts of poverty. It’s also exciting to see the White House legitimize the important work that One Degree and countless other organizations have been doing for years. 

The White House playbook stresses the importance of taking a “whole-of-government approach,” signaling a shift towards a coordinated effort to address health-related social needs in a field traditionally marked by fragmentation. A strategy at the national level undoubtedly paves the way for progress, but what’s also clear is that this playbook was developed primarily for federal government agencies. Underlying its approach is the assumption that top-down changes will trickle down to our communities. Experience has shown us that this is rarely the case, and we hope to see them expand their focus as follows. 

Adopting an Equity Framework

Central to addressing SDOH interventions is recognizing the true target: the deep-rooted inequities of race and class that drive poor health outcomes. The White House playbook needs a stronger race and class equity lens to ensure truly inclusive and effective strategies. This is particularly important in the health and human services sector, where interventions—including community health hubs, health technologies, and community-based services—have historically manifested as either paternalistic, savior-designed systems at their best or exploitative and predatory ones at their worst. Adopting a robust equity framework is, therefore, a necessary safeguard against perpetuating these historical patterns.

A clear example of the need for this focus is evident in recommendation 1.4: “Improve capacity of backbone organizations to make effective referrals.” This recommendation, while well-intentioned, encourages a top-down effort to develop and disseminate best practices, while neglecting to recommend funding for community-based service providers to design optimal referral practices at the local level. The recommendation mistakenly implies that the technical capacity of CBOs to exchange referrals is the primary issue. We dispute this and see a more significant concern: the lack of power-sharing and collaboration between backbone entities and CBOs in determining how referrals can best support patients and reflect CBO expertise. 

Such disconnects reflect power imbalances currently inherent to the social sector, ones we must address to improve SDOH interventions at the local level. Therefore, we recommend the adoption of the following equity frameworks, ones that we implement at One Degree and believe can be effective across the sector:

  1. Challenge Privatized and Proprietary Data Silos
    The playbook suggests breaking down silos within government and nonprofit organizations, which is commendable. However, this recommendation falls short by omitting the role of for-profit entities. In today’s digital era, data is a valuable asset, and private companies contracted by health and human services agencies often develop proprietary data silos that hinder cross-sector collaboration. For health and human services technology to meet community needs, it’s crucial to extend these guidelines to include for-profit tech vendors. Furthermore, we recommend that more substantial guidelines be developed for states to establish open, public infrastructure in alignment with federal data sharing goals to reduce fragmentation of local SDOH data.

  2. National Alignment on Outcomes and Impact
    A notable missed opportunity in the playbook is a unified strategy for national outcomes and impact measurement. While recognizing the uniqueness of each community, establishing national health equity indicators—similar to economic indicators, such as GDP and CPI—could unify the sector’s efforts towards a common goal. The current practice of communities independently defining outcomes disincentivizes collaboration and perpetuates fragmented SDOH interventions at the local level. A standardized, nationally agreed-upon framework would enable better strategies toward cohesive and quantifiable impacts.

  3. Investment in Public Digital Infrastructure
    Another significant omission is a call for public digital infrastructure. While the playbook touches on SDOH data standards and the role of backbone organizations, it fails to address the tendency of local backbone organizations to create isolated systems, exacerbating the existing fragmentation. To effectively counter this, we advocate for the development of a universally accessible public digital infrastructure. Such a system should cater to the needs of health systems, backbone organizations, and community-based organizations alike, creating a unified and integrated approach to health interventions across the nation.

Beyond the Playbook

We thank the White House for making SDOH intervention a national priority. To meaningfully address SDOH and advance the health of communities nationwide, we must push beyond the playbook’s starting points. A national vision that is rooted in equity, outcomes, and public investment is not just a suggestion, it’s fundamental for success. Otherwise, we run the risk of ceding the future of digital health and human services infrastructure to for-profit entities that are motivated solely by their bottom-line, not the well-being of low-income communities.