Achieving health equity is a priority item for health systems globally.  Collective international interest has heightened awareness and recognition of the pressing need for action.

Health inequity is the difference in health that results from the living and working conditions people experience, particularly relevant among vulnerable populations.  A serious and growing public health issue locally, nationally and globally, social determinants of health contribute to health inequity, with these factors ranging from early child development and education to working conditions, food security and income, gender, race and housing, etc.  On average, no fewer than 17 social determinants have been identified as capable of impacting an individual’s health.   

SNOMED International is committed to supporting the reduction of health inequity through developing and managing social determinants of health content within SNOMED CT’s clinical terminology.  To maximize accessibility of this content, SNOMED International plans to include all social determinants of health content within the organization’s Global Patient Set, a managed list of existing SNOMED CT unique identifiers, fully specified names, preferred terms in international English, and status flags, made openly available for global use.

Social Determinants of Health and SNOMED CT’s Clinical Terminology

A strategic direction for the ongoing evolution of SNOMED CT over the next 5 years is facilitating improvements in patient outcomes and meeting the needs of integrated health and social care systems in a sustainable fashion.

Defined as part of our strategic plan for 2020-2025, SNOMED International has initiated a project to gather requirements from stakeholders to enhance social determinants of health content coverage within SNOMED CT, while assessing its structure and placement within the SNOMED CT hierarchy.  Core to this approach is addressing existing gaps in SNOMED CT content to meet user requirements for electronic health records.

What is the practical use of this expanded content?  Once complete, SNOMED CT enabled systems will be equipped with the ability to record a person’s social and environmental status as factors to be considered in care planning and provision of related services.  Once captured using SNOMED CT, clinicians, researchers and policy makers can benefit from leveraging encoded health records for numerous avenues of analysis and for development of evidence-based practice, clinical guidelines and policies.

What has this project yielded so far?  Early analysis of SNOMED CT’s 350,000+ concepts indicates good coverage of concepts related to aspects of social determinants of health arranged across various hierarchies in no particular order for the content area.  Early phases of the project indicate that SNOMED CT is already representative of ~4,700 items of relevant content. This analysis is encouraging as SNOMED CT has a significant head start in building out social content to support this globally prevalent issue through SNOMED CT and the openly accessible Global Patient Set.    

In terms of what remains within the scope of the project slated to continue into 2022, outlining and confirming how social determinants of health content is used within the clinical record is critical to determining its structure and placement within the SNOMED CT hierarchy, and where gaps persist.

Collaborating Globally: The Gravity Project

The Gravity Project was initiated in November 2018 by The Social Interventions Research & Evaluation Network (SIREN) and is a direct response to calls to action around creating national standards for representing social determinant of health data in electronic health records in the United States.

Taking a consensus-building community approach, the Gravity Project has convened broad stakeholder groups, including SNOMED International, to identify and harmonize social risk factor data for interoperable electronic health information exchange.  The project seeks to identify coded data elements and associated value sets to represent social determinants of health data documented in EHRs across four clinical activities: screening, diagnosis, planning and interventions across three specific social risk domains: food insecurity, housing instability and quality, and transportation access.

Continuing beyond 2020, the outcomes of the Gravity Project will serve to inform the continued development and placement of this content within SNOMED CT, along with other sources of analysis and contribution.

Approaching Social Determinants of Health Content: Next Steps

This project represents SNOMED International’s commitment to advancing this area and is our first step in determining broad representative social care content for our global audience.  The organization is currently engaged in requirements gathering; and content development and hierarchy restructuring will be ongoing into 2022.