Advancing Sustainable Development Goals Through Integrated Health and Social Care

Report on the Integration of Clinical and Social Services

A significant policy discussion is underway regarding the integration of social care with clinical health services to more effectively achieve key Sustainable Development Goals (SDGs). The current healthcare model often fails to address the underlying social determinants that impact health, thereby hindering progress toward SDG 3 (Good Health and Well-being) and exacerbating conditions targeted by SDG 10 (Reduced Inequalities). Experts convened at the Johns Hopkins University Bloomberg Center to analyze strategies for creating a more holistic and equitable health system, particularly within the U.S. Medicaid program.

The Imperative for Systemic Change: Addressing Social Determinants of Health

The Disconnect Between Clinical Care and Social Realities

The efficacy of clinical interventions is frequently undermined by adverse social conditions. For millions of individuals, factors such as inadequate housing, food insecurity, and environmental pollution directly contradict medical advice and perpetuate cycles of poor health. This disconnect highlights a critical barrier to achieving universal health coverage and well-being for all ages as outlined in SDG 3. Addressing these social drivers is fundamental to building the sustainable and inclusive communities envisioned in SDG 11 (Sustainable Cities and Communities).

The Debate on Integrating Social Services into Healthcare

While there is growing consensus that social factors account for a large proportion of health outcomes, debate continues on the methodology and financial implications of integration.

• Proponents argue that combining clinical and social care can optimize prevention, improve health outcomes, and decrease overall costs, aligning with the SDG 3 target of creating more efficient and sustainable health systems.
• Opponents express concern that expanding the scope of healthcare to include social services could lead to inflated costs and challenges in defining the boundaries of health policy, particularly within the prevailing fee-for-service reimbursement model.

Policy and Programmatic Innovations in the United States

The Role of Medicaid in Fostering Integrated Care

In the United States, the Medicaid program has become a primary vehicle for testing integrated care models. States utilize Medicaid Section 1115 waivers to design and implement innovative approaches that deliver services beyond traditional clinical care. This mechanism fosters the cross-sectoral collaboration essential for SDG 17 (Partnerships for the Goals), allowing for tailored solutions that address the specific needs of vulnerable populations.

Case Study: North Carolina’s Pilot Program

In April 2022, North Carolina launched a pilot program using a 1115 waiver to provide food, housing, and transportation support. The program’s success offers compelling evidence for the integrated model’s potential to advance multiple SDGs.

• Services Provided: The program directly addressed targets related to SDG 2 (Zero Hunger) and SDG 11 (Sustainable Cities and Communities) by providing essential non-medical support.
• Program Outcomes: An independent evaluation after two years found a statistically significant reduction in emergency department visits and hospitalizations among participants, resulting in net savings of $85 per person per month.

These results demonstrate that investing in social determinants of health can lead to improved health outcomes and greater financial sustainability, key components of SDG 3.

A Proposed Framework for Achieving Health Equity and Sustainability

Strategic Innovations for an Integrated System

Vincent Guilamo-Ramos, executive director of the Institute for Policy Solutions at the Johns Hopkins School of Nursing, outlined a framework for effective integration that avoids the pitfalls of simply adding social services to a flawed fee-for-service system. This framework emphasizes a structural transformation of the health system to align with the holistic principles of the SDGs.

1. Reimagined System: Evolve the healthcare system to prioritize holistic prevention, primary care, and community-based services. This requires multidisciplinary, culturally responsive care teams, often led by nurses, to coordinate interventions that address health-related social needs. Such a system is foundational to reducing the health inequities targeted by SDG 10.
2. Bridged Infrastructure: Develop robust care coordination infrastructure and strategic partnerships among hospitals, health departments, social welfare organizations, and communities. This approach embodies the spirit of SDG 17 by creating a seamless network of support that reduces the navigational burden on patients and ensures continuity of services.
3. Strengthened Safety Net: Invest in a comprehensive social welfare infrastructure that addresses the root causes of poor health, including housing, food security, education, and transportation. Strengthening this safety net is essential for making meaningful progress on a wide range of SDGs, including SDG 1 (No Poverty), SDG 2, SDG 4 (Quality Education), and SDG 11, creating a more equitable and healthy society.

Effectively implemented, an integrated health and social care system represents a significant leap forward in achieving the 2030 Agenda for Sustainable Development by creating a model that promotes well-being, reduces inequality, and builds resilient communities.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being

  The article’s central theme is improving health outcomes and reforming the health care system by integrating social care. It discusses specific health issues like asthma and high blood pressure, and strategies to improve health services for the 80 million people on Medicaid.

• SDG 10: Reduced Inequalities

  The article explicitly focuses on eliminating health inequities by addressing the social conditions that disproportionately affect the health of vulnerable populations, particularly those covered by Medicaid. It highlights the need to ensure equal opportunity for good health by reforming policies and systems.

• SDG 1: No Poverty

  The discussion on providing housing and transportation support through Medicaid waivers directly addresses key dimensions of poverty. It frames these as essential “social care services” needed to improve health and well-being, aligning with social protection systems for the vulnerable.

• SDG 2: Zero Hunger

  The article identifies food security as a critical social driver of health. It mentions the lack of grocery stores in some neighborhoods and cites a North Carolina pilot program that provided “food support” as a core service to improve health outcomes.

• SDG 11: Sustainable Cities and Communities

  The article connects health issues to the living environment, citing examples like homes “located near factories or congested roadways that heavily pollute the air.” It also discusses the need for access to essential services like housing, transportation, and grocery stores within communities.

Specific Targets Identified

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental and physical health and well-being. The article addresses this by discussing the management of chronic conditions like asthma and high blood pressure through integrated social and clinical care, aiming to prevent severe flare-ups and improve overall health.
  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services… The article is centered on the Medicaid program, which is described as “the largest single source of health care coverage in the U.S.,” and explores innovative ways (like 1115 waivers) to improve the quality and effectiveness of the services it provides to 80 million people.
  • Target 3.9: By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. The article directly links air pollution from “factories or congested roadways” to “severe asthma flare-ups,” highlighting an environmental cause of illness that integrated care aims to mitigate.

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status. The article’s focus on improving health outcomes for Medicaid recipients is a direct effort to address the specific needs of a low-income, vulnerable population and reduce health disparities.
  • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome… The article advocates for systemic changes to the health care system to “eliminate health inequities.” The use of Medicaid 1115 waivers is presented as a policy tool to test and implement approaches that provide more equitable health outcomes.

• SDG 1: No Poverty

  • Target 1.3: Implement nationally appropriate social protection systems and measures for all… The Medicaid program, particularly with the 1115 waivers that provide housing and transportation support, functions as a social protection system. The article discusses strengthening this “safety net” to address the social needs of the poor and vulnerable.

• SDG 2: Zero Hunger

  • Target 2.1: By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations… to safe, nutritious and sufficient food all year round. The article identifies “food security” as a key social determinant of health and cites the North Carolina program that provided “food support” to Medicaid recipients as a successful intervention.

• SDG 11: Sustainable Cities and Communities

  • Target 11.1: By 2030, ensure access for all to adequate, safe and affordable housing… The article explicitly mentions providing “housing support” as part of the North Carolina pilot program to improve health, recognizing housing as a critical social need.
  • Target 11.2: By 2030, provide access to safe, affordable, accessible and sustainable transport systems for all… The article identifies “transportation support” as another key service provided in the pilot program, essential for accessing health care and other necessities.

Indicators Mentioned or Implied

• Reduction in Emergency Department Visits and Hospitalizations

  The article explicitly states that an independent evaluation of the North Carolina pilot program found a “statistically significant reduction in emergency department visits and hospitalizations among program participants.” This is a direct quantitative indicator of improved health outcomes and system efficiency.

• Cost Savings per Person

  The article quantifies the financial impact of the integrated care program, noting it “netted savings of $85 per person per month.” This serves as a key indicator for measuring the financial sustainability and cost-effectiveness of the new model.

• Number of People Covered by Integrated Services

  The article mentions that the North Carolina pilot program “offered food, housing, and transportation support, among other services, to more than 13,000 people.” This number serves as an indicator of the reach and coverage of the social care intervention.

• Population Covered by Health Insurance

  The article implies an indicator for universal health coverage by stating that “Medicaid is central to the health care of about 80 million people in the United States.” This figure represents the proportion of the population covered by this specific public health program.

SDGs, Targets, and Indicators Analysis

Source: hub.jhu.edu