IHPS Current Work in Social and Environmental Determinants of Health

Rita Hamad, MD is a social epidemiologist and family physician at the Philip R. Lee Institute for Health Policy Studies and the Department of Family & Community Medicine at UCSF. She is the director of the Social Policies for Health Equity Research Program and the Associate Director of the Center for Health Equity. Her research focuses on the pathways linking social factors like poverty and education with racial and socioeconomic disparities in health.

Her recent work includes research on the effects of school segregation on Black children. Using a natural experiment, SPHERE researchers found segregated schools harm Black children's well-being by propagating a harmful cycle of intergenerational inequities driven by structural racism. Read more in the SPHERE School Segregation Research Brief.

Dr. Hamad is currently investigating and documenting the differences in local social and public health policies that emerged during the COVID pandemic. Dr. Hamad and colleagues have created The U.S. COVID-19 County Policy Database. By making these data publicly available, this work supports future research that can leverage this database to examine how policies contributed to pandemic-related health and socioeconomic outcomes and disparities. The UCCP database is available online and will soon include additional time points for 2020-2021 and more counties nationwide.

In his role as MPI on the NIMHD Research Coordinating Center for Disparities Research in Multiple Chronic Disease, Stuart Gansky, MS, DrPH is leading the adoption and collection of a set of common data elements in social determinants of health, comorbidities, and self-rated health for the NIMHD Multiple Chronic Disease Disparities Research Consortium also known as the Health Equity Action Network 

Laura Gottlieb, MD is the founding co-director of the Social Interventions Research and Evaluation Network (SIREN), a national research network that advances research on health care strategies to improve social conditions. SIREN recently hosted the SIREN 2022 National Research Meeting: Racial Health Equity in Social Care. The plenary recordings from the three-day meeting are available now. They feature a visionary discussion between Rhea Boyd, Osagie Obasogie, and Darion Wallace on what social care can learn from abolition work in other sectors; a candid conversation between Monica Peek and Crystal Cene on how much (or little) racial health equity has been explored in social care intervention research followed by a poignant poetry reading by Ryan Petteway;  and a closing plenary featuring some of our Expert by Experience advisors’ (Lisa Hamlett, Mike McNear, Ann Reynoso, and Stephanie Walker) reflections on their takeaways from the meeting, what was most important to them, and what they see as opportunities for more research and action. More meeting content will become available on the SIREN website soon.  

Courtney Lyles, PhD is part of a research team at UCSF, working closely with local community-based organizations (CBOs) in San Francisco Bay Area, who co-designed and built MAVEN (Mapping to Amplify the Vitality of Engaged Neighborhoods)—an open-source tool hosted in Salesforce for CBOs to support community leaders in their resource referral process to address social determinants of health. With integrations to ServiceMatch, SF Resource Guide, and Twilio, the MAVEN tool provides 1) access to a database of hundreds of San Francisco health and social resources (such as food or housing services), 2) simple navigation to search or receive recommendations about the right resources for client(s), and 3) easy ways to text or email the resource information to clients. The inclusion of features such as bi-directional communication via SMS and forums can facilitate better client and community engagement, and the ability to feed in a directory like SF Resource Guide allowed up-to-date resource data to flow into the platform in real time. Lyles and colleagues have shared their findings from a qualitative study supplemented by descriptive quantitative analysis that investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. In another paper, Lyles and colleagues shared findings from interviews, neighborhood tours, and clinic visit observations in San Francisco to understand important influences on health and wellness for patients who have been historically and presently marginalized within society (for example, those from racial/ethnic minority groups or facing poverty).  Lyles and colleagues also shared findings about why health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.

Hilary Seligman, MD focuses on food insecurity and its health implications across the life course, including the impact of federal nutrition programs (particularly SNAP) and the charitable food network (including food banks, voucher programs, and medically tailored meal programs). She also studies food affordability and access, and income-related drivers of food choice. In her research, she also focuses on conducting strategic science that influences policymakers to create policy, systems and environmental changes to improve access to food for Americans experiencing food insecurity.

Her work for Feeding America has supported substantive changes to the charitable feeding network which influence the food which shows up in food pantry settings. This work, which is conducted in collaboration with many others, includes: (1) the incorporation of behavioral economics principles into food pantry settings to make the healthy choice the easy choice; (2) the development of a Nutrition Policy for the Feeding America National Organization (the umbrella organization for the 200 state, regional, and local  food banks in the US); (3) the development of chronic disease programs within food banks to better support the dietary needs of the large proportion of their clients who have or at risk for obesity, diabetes, and cardiovascular disease; (4) strategies to change the sourcing and distribution of food within the charitable feeding system to align with USDA dietary guidelines, and (5) in 2020, the creation of the Healthy Eating Research Nutrition Guidelines for the Charitable Food System which has been adopted by Feeding America. This work influences the more than 49 million people touched annually by a Feeding America food bank.

She has directed the CDC’s Nutrition and Obesity Policy Research & Evaluation Network (NOPREN) since 2014, in addition to directing NOPREN’s Food Security work group.  This work allows her to work closely with CDC’s Division of Nutrition, Physical Activity, and Obesity on numerous topics related to nutrition policy.

Dean Schillinger, MD is a co-PI of a CDC/NIDDK jointly-funded natural experiments projects with Rita Hamad, MD, PHD; Hilary Seligman, MD and Marianne Bitler, PhD on the health effects of addressing food insecurity through SNAP and WIC.

Food insecurity is a common and potent mediator in the development of type-2 diabetes (T2D) and diabetes-related complications among low-income populations in the USA. The first sub-study relates to older low-income adults. In 2019, California began to allow low-income, older, and/or disabled individuals receiving Supplemental Security Income (SSI)—populations with a high prevalence of food insecurity and risk for T2D and diabetes complications—to receive simultaneous benefits from the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps). This sub-study will harmonize and analyze statewide longitudinal datasets (including hospital discharge data) using a quasi-experimental pre/post design to determine whether the addition of the SNAP benefit for older low-income adults is associated with county-level reductions in multiple outcomes, including diabetes-related hospitalizations, individual-level improvements in cardiometabolic control among individuals with type-2 diabetes (T2D), and reduced incidence of T2D among individuals with prediabetes. The second sub-study will evaluate the effects of a separate policy that allowed recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—a program that provides nutrition support to low-income pregnant and postpartum women and children under the age of 5—to receive an electronic benefit card rather than paper vouchers. The sub-study will examine whether this policy change leads to increased WIC benefit uptake and reductions in gestational diabetes and other pregnancy-related complications among pregnant women and in unfavorable birth outcomes associated with diabetes risk in their children such as low birth weight.