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Sunday, May 12, 2019

SDH Lexicon

May 2019 | Hugh Alderwick, Laura M. Gottlieb | Early View, Perspective
Policy Points:
  • Health care systems and policymakers in the United States increasingly use language related to social determinants of health in their strategies to improve health and control costs, but the terms used are often misunderstood, conflated, and confused.
  • Greater clarity on key terms and the concepts underlying them could advance policies and practices related to social determinants of health—including by defining appropriate roles and limits of the health care sector in this multisector field.
The language of the social determinants of health is currently in vogue in US health care. Yet the same words and concepts, such as social determinants of health and population health, are often used in different ways—sometimes with very different objectives.1 This, for fans of the later Wittgenstein, is how language works: the meaning of words is in their use.2 Confusion over health care jargon is nothing new.3,4 But misunderstandings over meanings could have important implications as a growing number of health care systems design new interventions to respond to patients’ social circumstances. New collaborations among the health care, public health, and social services sectors5—each often arriving with different ways of thinking about social determinants of health and social interventions—would benefit from a shared understanding of the language being used and what it means for achieving their objectives. Clarity would also benefit policymakers exploring (and testing) new payment systems and policies to incentivize greater health care investments in social supports.6-9 This is particularly important given the potential unintended consequences of bringing language and information related to patients’ social circumstances into a market-based health care system.10

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