Social Determinants of Health (SDOH) in Focus: Addressing Our Nation’s Homelessness Crisis
By Frannie Yin and Sophie Lamarche
Healthcare is not solely dependent on medical care provided by healthcare professionals and facilities. There are various nonmedical factors known as Social Determinants of Health (SDOH) that significantly impact an individual’s health outcomes. These factors include socioeconomic status, neighborhood conditions, language and literacy, transportation, and more. Surprisingly, SDOH contributes to 80–90% of health outcomes, while medical care only accounts for 10–20%.
Despite the overwhelming influence of SDOH on health, our healthcare system has primarily focused on reactive and individual-centric care. To improve the overall health of communities and populations, a more holistic approach is necessary–one that addresses the root causes of health issues by considering SDOH. By adopting this proactive perspective, we can reduce the burden on medical systems, diminish health disparities, and promote health equity.
Healthcare disparities, which arise from social, economic, and environmental sources, disproportionately affect underserved and disadvantaged populations. Access to healthcare is a significant SDOH influenced by economic status. Individuals with lower socioeconomic status are more likely to be uninsured and face barriers to seeking care, resulting in poorer health outcomes. By collectively addressing SDOH, we can implement targeted solutions to improve the health outcomes of underserved populations, reducing disparities and ensuring health equity for all.
The government and non-profit sectors encompass numerous organizations that have a direct impact on SDOH. These organizations have a valuable opportunity to incorporate a public health perspective into their work, positively influencing the health outcomes of the communities they serve.
Housing as a Social Determinant of Health
Access to safe and affordable housing, along with the necessary support to maintain it is fundamental to good health. Housing instability has a negative impact on physical health and hinders access to healthcare. Studies have shown that populations experiencing housing instability have higher rates of morbidity and mortality, resulting in increased healthcare costs. From the perspective of SDOH, housing can be considered a form of healthcare.
Homelessness represents the most severe form of housing insecurity. In 2022, the US Department of Housing and Urban Development (HUD)’s annual “point in time” (PIT) count reported over half a million people experiencing homelessness on a single night. The PIT count is widely regarded as an undercount, underscoring the magnitude of our national housing crisis. Seattle, WA, where Slalom is headquartered, is known for being one of the cities with the largest rates of homelessness. Our PIT count for King County, WA found 13,368 individuals experiencing homelessness on a single night in January 2022, but cross-systems estimates suggest that over 50,000 people experienced homelessness throughout the last year in our region. Models indicate this number could rise to over 60,000 by 2028 without significant change to our response.
As is the case with many other large American cities, Seattle’s booming economy and growing wealth is paradoxical compared to the housing crisis and rising levels of housing instability. A key reason for these discrepancies is that the local housing stock has failed to keep up with population and job growth, and the subsequent shortage has resulted in increased rent prices and an increased cost burden of housing. A household is considered cost-burdened if they spend over 30% of their income on housing. Disproportionately high spending on housing results in less residual funding for other necessities such as food and healthcare, leading to poor health outcomes.
So, what is the path forward? To address the housing crisis, a coordinated and community-wide approach is necessary. Increasing the availability of affordable housing is crucial, as it reduces housing instability and cost burdens for households with incomes below the area median. For those experiencing homelessness, the “Housing First” approach, which prioritizes stable housing as a prerequisite for addressing additional challenges, has proven successful in improving housing stability and certain aspects of health. However, it is important to provide supportive services alongside housing to ensure individuals can maintain their housing and thrive. When “Housing First” refers to a “housing only” solution, it becomes largely ineffective. Individuals who have been chronically unhoused cannot be expected to succeed solely off the provision of a housing voucher. Some liken it to how the majority of those who win the lottery end up bankrupt shortly thereafter.
Around the nation, numerous organizations and initiatives are working tirelessly to combat homelessness and provide comprehensive support to individuals in need. By focusing on a housing-first approach and offering wraparound services, these organizations are making a significant impact on reducing homelessness and improving health outcomes for the affected population. An exemplary organization providing both housing, case management, and community, is one of Slalom’s own customers: the Low Income Housing Institute (LIHI). LIHI’s tiny home village model is one of the most successful housing solutions in Seattle, with over half of residents exiting to permanent housing (compared to traditional congregate shelter models, which only see 14–19% success). As this data demonstrates, the provision of housing alone is rarely successful without the proper support to help individuals maintain and be happy in that housing. Check out this case study for more information on how Slalom enabled the nonprofit to focus less on paperwork and more on ending homelessness!
At Slalom, we feel a sense of moral obligation to contribute meaningfully to the well-being of our communities and are committed to leaving our people, clients, and the environment better off than when we found it. Building better tomorrows for all starts with investing in the communities where we live, work and play — including how we address the housing crisis as a SDOH by developing platforms that connect individuals in emergency crisis with shelters and services in real-time. Slalom’s Accommodation and Services Matching solution, powered by Salesforce and AWS, does just that — connecting people in crisis with the shelter and services that they need with a real-time, mobile-friendly web platform that integrates with other providers, government agencies, and systems across local continua of care. Data around housing and homelessness is notoriously unavailable, and often unreliable, but this Slalom solution is bringing visibility into live housing inventory levels and helping reduce silos between the many disparate webs of processes and systems of agencies working to match services to those in need.
By recognizing and addressing the multifaceted impact of housing and related factors on health, we can work towards creating healthier communities and achieving health equity for all.
Slalom is a global consulting firm that helps people and organizations dream bigger, move faster, and build better tomorrows for all.
