Social determinants language has made its way into the health reform bills passed by the House and Senate committees. Nearly hidden beneath the myriad details of health coverage for all are a few notable provisions that are (quietly) calling for:

• Investment in community health infrastructure;
• Support for evidence-based community interventions;
• Use of health impact assessments;
• Focus on health disparities;
• Emphasis on public health and prevention; and a
• Broader, multi-disciplinary approach to national health policy and metrics.

(See social determinants highlights and bill comparisons by American Public Health Association and Kaiser Family Foundation.)

While we are encouraged, we also know this is a long way from officially (and vociferously!) declaring social determinants as a national priority. Most concerning is the relatively limited attention these particular provisions are getting in news coverage and the public discourse.

Without broad-based, ongoing awareness-building that reframes (see previous post) our understanding of health and what determines health, provisions like these are too easily discarded as pork rather than essential long-term investments in a healthier nation. We got a whisper when we need roar.