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VHA Community Partnership Challenge

Community Partnership Challenge series: How Veterans Hub and VHA’s Office of Health Equity Address Social Determinants of Health

This is the sixth in a series of articles about how various VA and VHA offices, initiatives, and programs support social determinants of health—the theme of the 2020 VHA Community Partnership Challenge. The sixth Community Partnership Challenge series feature: Veterans Hub and VHA’s Office of Health Equity. 

Veterans Hub, part of the 100 Million Healthier Lives movement, is on a mission to help 20 million Veterans live healthier lives in 2020 by focusing on improving their social determinants of health (SDOH). The SDOH are conditions in environments where Veterans live, learn, play, worship, and age.

Veterans Hub, led by the Veterans Health Administration (VHA)’s Office of Community Engagement (OCE), is working to accomplish this mission through unprecedented collaboration with more than 60 individuals and organizations within VHA and in other government and community organizations. VHA’s Office of Health Equity (OHE) is just one example of a VA program office that is working to bring more SDOH-related health-focused services to Veterans.

When Veterans have access to critical needs such as transportation, employment, health care, and fresh, healthy foods, they have better health outcomes. Social factors like these are so critical to Veteran health that they are the theme of 2020 VHA Community Partnership Challenge, an annual contest hosted by OCE that highlights nonmonetary, community-level partnerships between VHA and nongovernmental organizations that serve Veterans, their families, caregivers, and survivors.

Dr. Ernest Moy, executive director of OHE and a health services researcher and internal medicine doctor who has spent most of his career studying health care equity, said VHA is well-positioned to help Veterans access positive SDOH. Clinical providers outside VHA can provide medical advice and medications, but they typically cannot address patients’ housing, food security, or financial issues that can hamper their care.

Within VHA, he said, there are not significant financial barriers to health care, plus VHA is part of the larger VA system that can address SDOH deficits through initiatives such as those to eliminate homelessness, VA home loans to provide affordable mortgages, food banks that are located within VA medical centers, the GI Bill, which provides education benefits to Veterans that can lead to good paying jobs, and access to employment opportunities for Veterans.

OHE supported the development of the Assessing Circumstances Offering Resources for Need (ACORN) social needs screener used in the VA New England Healthcare System to identify any SDOH deficits that patients face and local-level resources that can help alleviate those issues.

One SDOH that comes up frequently is social isolation, according to Dr. Moy. It is especially a concern for older Veterans who are living alone and away from family and friends.

“It can have a big impact on their lives. They’re less compliant with their medications and instructions, and eventually, this can lead to them having to move into a nursing home,” said Dr. Moy.

Now with the coronavirus pandemic impacting everyday life, “how you are living is going to strongly affect the likelihood that you will contract the disease,” he added. With that in mind, OHE is now promoting use of a COVID-19 special risk screener so health care providers can understand their patients’ social circumstances, which can affect their risk for infection. For example, Veterans are asked if they leave home to go to work or to get groceries, whether they use public transportation, how many people they live with, and whether the residence is a single-family home versus an apartment building, where multiple people are touching common surfaces such as door handles and elevator buttons.

As the screening gets built in to VA’s computerized patient record system, retention of this data could make a difference in the lives of Veterans should COVID-19 cases die down over the summer and pick up again in the fall, Dr. Moy said.

“We can do more proactive counseling by knowing who’s at high risk,” said Dr. Moy. For instance, if someone who was screened in the spring was found to have social risks, but didn’t contract COVID-19, that Veteran would be at the top of a list to call back in the fall as a reminder that they should be particularly watchful and observant, he said.

Dr. Moy has been active in the Veterans Hub, providing the unique perspective and resources related to health equity across the populations of Veterans. He said the work his office does in collaboration with the VA New England Healthcare System leads to connecting Veterans with services, relying on social workers who have access to resources outside VA. Once resources have been identified, OHE also submits them to the National Resource Directory, a partnership between the U.S. Departments of Defense, Labor, and Veterans Affairs, which Veterans and service members can access online.

For more information on OCE’s work or to contact OCE for partnership opportunities, please visit:

For more about the Community Partnership Challenge and social determinants of health, please see our series of stories on Veterans Transportation Service, Office of Patient Centered Care and Cultural Transformation, Medical-Legal Partnerships, the Veterans Experience Office and the Community Veteran Engagement Board, and the Hampton Roads Veteran Community Partnership.

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Posted July 9, 2020