Health-Related Social Needs

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report always/usually/sometimes feeling socially isolated. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Current

Loneliness is defined as the discrepancy between a person’s desired and actual social relationships and is sometimes considered synonymous with social isolation, although they are two distinct concepts1. Loneliness is an emotional response to social isolation, while social isolation is an objective measure of the lack of social interactions and relationships1. Previous studies show that social isolation and loneliness are common sources of chronic stress in adults23, and are common at the end of life, affecting 1 in 4 older adults4. Positive relationships and interactions with family, friends, co-workers, and community members can have a protective impact on individual health and well-being, and these relationships can also help mitigate the negative impacts of challenges that people face (e.g., living in an unsafe neighborhood, trouble affording housing or food)5. Past research shows that people with high levels of social isolation6 are at higher risk of developing chronic conditions (e.g., depression, cardiovascular disease, hypertension, cancer) and have a higher risk of mortality78.

This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who reported receiving food stamps, also called SNAP, the Supplemental Nutrition Assistance Program, on an EBT card. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Past 12 months

Food insecurity is defined as the inability to afford nutritionally adequate and safe foods9. There is a growing literature documenting relationships between food insecurity and chronic diseases101112. The Supplemental Nutrition Assistance Program (SNAP) has shown a substantial reduction in the prevalence of food insecurity and negative health outcomes13. Unmet social needs can impact health through disease outcomes, such as chronic stress, and by further impacting the ability to access needed resources14. Unmet social needs themselves may be influenced by larger structural determinants of health and may be differentially experienced by people of vulnerable population groups. Addressing both individual and population level unmet health related social needs can help reduce adverse health outcomes151617.

This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

Healthy People 2030 objective: NWS‑01. Reduce household food insecurity and hunger.

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who reported that the food that they bought always/usually/sometimes did not last, and they didn’t have money to get more. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Past 12 months

In 2023, around 18 million US households reported being food insecure at some time during the year18 People with low income, people with a disability, and some racial/ethnic groups are more likely to experience food insecurity181920. Limited physical access to healthy foods and transportation options in neighborhoods can also increase a person’s risk for food insecurity21. Food insecurity is associated with chronic and acute health problems and health care needs in children20, and food-insecure adults are at a higher risk of developing several chronic conditions, including coronary heart disease, diabetes, obesity, and cancer1922. Connecting individuals and families who are food insecure to food and income assistance programs can help to address food insecurity21.

This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

Healthy People 2030 objective: NWS‑01. Reduce household food insecurity and hunger.

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who were not able to pay mortgage, rent, or utility bill in the past 12 months. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Past 12 months

Literature has shown that housing insecurity or instability is associated with limited access to health care23 and poor health outcomes24. Housing cost burden (spending more than 30% income on housing) is one challenge of housing instability, which also includes housing quality, overcrowding, and moving frequently2526. In 2022, 42.1 million households were cost-burdened25. People who are renters, people living in urban areas, and some racial and ethnic minority groups are more likely to experience a housing cost burden2728. Living in unaffordable housing is associated with overall poor health and increased risk of disease, including hypertension and cardiovascular disease2526. Programs that make housing more affordable for both renters and homeowners and housing subsidies that provide financial assistance to pay rent can help improve housing cost burden2528. Recent systematic reviews show that permanent supportive housing interventions increased long-term housing stability, reduced homelessness29, and improved health outcomes related to human immunodeficiency virus, anxiety, and depression among people experiencing homelessness30.

Indicator does not convey a comprehensive measure of housing instability. The indicator does not include housing and neighborhood safety, housing quality, crowding, or residential stability (moving frequently). This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

Healthy People 2030 objective: SDOH-04. Reduce the proportion of families that spend more than 30 percent of income on housing.

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who reported that an electric, gas, oil, or water company threatened to shut off services at any time during the prior 12 months. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Past 12 months

Unmet social needs can impact health through disease outcomes, such as chronic stress, and in further impacting the ability to access needed resources14. Unmet social needs themselves may be influenced by larger structural determinants of health and may be differentially experienced by people of vulnerable population groups. Addressing both individual and population level unmet health related social needs can help reduce adverse health outcomes151617.

This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

None

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who reported a lack of reliable transportation keeping them from medical appointments, meetings, work, or from getting things needed for daily living in the past 12 months. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Past 12 months

Nearly 2% of the U.S. population delayed medical care because they did not have transportation in 201731. Lack of available, convenient, or reliable transportation can affect a person’s ability to consistently access health care services, which can lead to delays in healthcare and medication use that can subsequently impact overall health3233. In addition, the inability to access reliable transportation to work, schools, and grocery stores is associated with higher rates of unemployment, poverty, and chronic illness34. People with lower incomes and uninsured people are more likely to experience transportation barriers3334. Limited public transportation infrastructure in a neighborhood leaves people without access to vehicles lacking in reliable transportation options34. Offering free or reimbursed public transit or taxi costs, connecting individuals to transportation, and policies that improve the safety and accessibility of sidewalks and bike lanes can help improve transportation access3435.

This measure used the survey question that is part of the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. This measure is only available for states that chose to administer the module.

All Adults

A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report sometimes, rarely, or never getting the social and emotional support needed. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.

Prevalence (crude and age-adjusted)

Current

Positive relationships and interactions with family, friends, co-workers, and community members can have a protective impact on individual health and well-being, and these relationships can also help mitigate the negative impacts of challenges that people face (e.g., living in an unsafe neighborhood, trouble affording housing or food)5. Past research shows that people with high levels of social isolation (lack of interactions with others or the wider community)6 are at higher risk of developing chronic conditions (e.g., depression, cardiovascular disease, hypertension) and have a higher risk of mortality7.