SDoH Hardship Continues to Worsen: What's the Trauma Tipping Point?

This article appears with explicit permission of RACMonitor; a version of this story was published 8/19/21

There was tremendous buzz last week about the U.S. Census report on shifting demographics across the country. Yet the greater concern in the area of the social determinants of health (SDoH) is mitigating prevailing gaps in care.

What happens when society’s most vulnerable populations grow due to a pandemic? Just how much trauma can populations endure? Healthcare history was made when hospitals and healthcare organizations struggled with increased utilization from rising admissions and readmissions, a more clinically complex case mix of higher-acuity admissions, and of course, increased length of stay. Then came the worst of the COVID pandemic, which only widened health and mental health disparities, and pushed organizations to the brink.

There was light at the end of the tunnel, however. Unemployment and other hardship indicators normalized by June 2021; jobs were more abundant, food insecurity improved, and housing shortages ebbed. Hospitals and their emergency departments settled back into a routine, but the latest COVID onslaught has again put pressure on organizations to render more care to those who have less. A new report by the Center on Budget and Policy Priorities reveals dramatic hardships expanding across populations in recent months. By now we all know what that means: delays in treatment and surgeries that prompt more clinically complex patients, and higher rates of resource utilization.

Here are some highlights from the report’s data, pulled from the U.S. Census Bureau’s ongoing Pulse Survey:

• Close to 30 percent of the population continues to have trouble covering financial expenses, with 15 percent unable to cover rent. With unemployment still at 5.4 percent, much of the population has not caught up on rent or mortgage payments:
  • 16 percent of renters are more likely to be challenged, especially those of color:
    • 24 percent of Black renters, 18 percent Latino, 18 percent Asian, and 11 percent American Indian/Pacific Islanders.
• At least 20 million adults, roughly 10 percent of the population, lack enough to eat.
• Households with children have among the highest hardship rates, with food hardship higher during the pandemic than at any other time in history:
  • Roughly 14 percent, or 1 out of every 7 families, lacked sufficient food for one week;
  • Black and Latino families were twice as likely as white adults to report insufficient amounts of food:
    • 19 percent of multi-racial individuals
    • 17 percent for Black adults
    • 16 percent for Latino adults
    • 7 percent for whites
    • 5 percent for Asians
• States with the 10 highest percentages of adults and children dealing with food insecurity include:
  • Hawaii: 22%
  • Alabama: 19%
  • Arkansas: 19%
  • New Mexico: 20%
  • Louisiana: 18%
  • Nevada: 17%
  • Georgia: 17%
  • California: 16%
  • Mississippi: 16%
  • South Carolina: 16%
• The states or territories with the five highest unemployment rates were:
  • Puerto Rico: 8.2%
  • Hawaii: 8.1%
  • Connecticut: 8.0%
  • California: 7.9%
  • Nevada: 7.9%

It’s tough to consider that increased Supplemental Nutrition Assistance Program (SNAP) benefits will expire at the end of September. However, an Aug. 16 announcement will yield a major change for persons impacted by food insecurity. Under new rules to be instituted in October, average benefits will rise 25 percent, or $36, from the pre-pandemic levels of $121 per person. This shift will impact more than 42 million SNAP recipients. The move does not require congressional approval, and unlike the large pandemic-era expansions, which are starting to expire, the changes are intended to last.

Greater societal hardship translates to increased fiscal pressures for healthcare organizations, as they deal with greater use, worsening clinical outcomes, and thus financial hardships. At what point does the mandate for trauma-informed practices become a mandate for all sectors and settings? This week’s Monitor Mondays Listeners Survey asked how many of our listeners know someone (whether a patient or personal acquaintance) who has been to a food bank in the past six months; the results spoke volumes and appear here. Nobody is immune from the ongoing stressors of the pandemic, for those most at-risk members of society, the trauma mandates clear action and intervention.