Social determinants of health

Proposed and experimental methods

Methods that are proposed, under trial, approved in some places, or tried and then failed. Each shows a stage label and an evidence rating. A stage label shows how far a method has progressed, not whether it works. The stage labels are explained on the societal factor page.

• Housing with case management for homeless adults (Large trial, B). Housing First gives housing without preconditions, plus support. In the At Home/Chez Soi trial of 1,198 homeless adults with mental illness in four Canadian cities, scattered-site housing with rent supplements and intensive case management increased days stably housed over 24 months, although the size varied by site, but did not improve general quality of life (Stergiopoulos et al., 2015).
• Social prescribing (In wide use, contested, C). General practitioners refer patients to link workers who connect them with community support. A systematic review of 15 UK evaluations found most were small, poorly designed, and at high risk of bias, yet most reported positive conclusions, and judged that the evidence was not enough to assess success or value for money (Bickerdike et al., 2017).
• Not shown to help: Intensive food-as-medicine program (Large trial, B). In a randomized trial of 465 patients with type 2 diabetes and food insecurity, a program providing healthy groceries for 10 meals a week plus dietitian and nurse support increased preventive care, but HbA1c fell in both groups and the difference at 6 months was not significant (-0.10, 95% CI -0.46 to 0.25) (Doyle et al., 2024).
• Failed: Health care "hotspotting" with social service links (Failed or reversed, B). The Camden Coalition program sent nurses, social workers, and community health workers to coordinate care and link very high users of hospitals to social services. In a randomized trial of 800 patients, 180-day readmission was 62.3% with the program versus 61.7% with usual care, while a before-and-after comparison had misleadingly suggested a 38-percentage-point decline (Finkelstein et al., 2020).
• Reversed: Medicaid coverage of health-related social needs (Failed or reversed, B). U.S. federal guidance from 2023 and 2024 let states use Medicaid to pay for supports such as housing and nutrition. On March 4, 2025, the Centers for Medicare & Medicaid Services rescinded that guidance and the framework behind it and said it would review future state applications case by case (Centers for Medicare & Medicaid Services, 2025).

Sources cited on this page

1. WHO Commission on Social Determinants of Health (2008). Closing the Gap in a Generation. WHO IRIS B Moderate: for evidence, recommendations not rated
2. Marmot, M. (2004). The Status Syndrome. New York: Times Books. A Strong: for the health gradient, B for status as the cause
3. Bickerdike, L., Booth, A., Wilson, P. M., Farley, K., & Wright, K. (2017). Social prescribing: Less rhetoric and more reality. A systematic review of the evidence. BMJ Open, 7(4), e013384. link C Limited
4. Doyle, J., Alsan, M., Skelley, N., Lu, Y., & Cawley, J. (2024). Effect of an intensive food-as-medicine program on health and health care use: A randomized clinical trial. JAMA Internal Medicine, 184(2), 154-163. link B Moderate
5. Finkelstein, A., Zhou, A., Taubman, S., & Doyle, J. (2020). Health care hotspotting: A randomized, controlled trial. New England Journal of Medicine, 382(2), 152-162. link B Moderate
6. Stergiopoulos, V., Hwang, S. W., Gozdzik, A., Nisenbaum, R., Latimer, E., Rabouin, D., et al. (2015). Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: A randomized trial. JAMA, 313(9), 905-915. link B Moderate

Every source for this factor is listed on the societal factor page.