Medicare looks at the impact of social determinants of health - Episcopal Health Foundation

For the first time, the Centers for Medicare and Medicaid Services (CMS) published a report on how unmet social needs — things like housing and human connection — shape the health of Medicare patients. The findings are a reminder that good health depends on more than doctor visits.

CMS looked at 33.7 million Medicare patients in 2017. Of those, 467,000 had at least one documented social need — things like homelessness or social isolation (feeling cut off from other people). The two most common chronic conditions tied to those needs were high blood pressure and depression. The report also found clear gaps by gender and race: homelessness showed up more often among male patients, while social isolation was more common among female patients. Black and American Indian or Alaska Native patients experienced homelessness at more than three times the rate of White patients. CMS flagged that these numbers are likely an undercount — many social needs go undocumented in medical records.

Use what you learned here to ask better questions. When you or a loved one sees a doctor, you can mention non-medical challenges — housing stress, loneliness, food access — because those details can shape the care you receive. You can also look for community programs and health plans that address social needs, not just medical ones.

No fixed date

Not location-specific

This report connects to broader conversations about social determinants of health (SDOH) — the non-medical factors that shape wellbeing. In Houston, organizations focused on housing, food access, and mental health are part of the same picture. If you or someone you know needs help finding local resources, community health workers and social service agencies can be a good starting point.

Where you live, who you live with, and whether your basic needs are met directly affects your health. This report puts numbers to what many Houstonians already know from lived experience. Understanding these connections helps you advocate for yourself, your family, and your neighbors.