The researchers focused on Social and Digital Determinants of Health, or SD-DOH. Traditional social determinants include housing stability, food access, transportation, employment, education, neighborhood safety, and social connection. Digital determinants add another layer, including internet availability, device ownership, digital literacy, access to telehealth, the usability of online patient portals, and the ability to navigate increasingly technology-dependent health systems. These factors can determine whether a patient receives an appointment reminder, completes a telemedicine visit, finds trustworthy health information, or remains connected to clinicians after leaving a hospital. As healthcare rapidly adopts artificial intelligence, remote monitoring, online scheduling, and virtual care, unequal digital access can amplify existing racial, geographic, economic, and age-related disparities.

To investigate how organizations respond, the team conducted a PRISMA-ScR-guided scoping review and qualitative evidence synthesis. The researchers searched PubMed, Scopus, ProQuest, and CINAHL for U.S.-based peer-reviewed and gray literature published from January 2020 through June 2025. They identified 94 sources that described the perspectives of healthcare leaders or other organizational stakeholders on responsibility for addressing SD-DOH. Rather than treating responsibility as a single activity, the researchers analyzed the literature through two complementary frameworks: four strategic levers used by health systems and an expanded version of the National Academy of Medicine’s five-part social care framework.

The four strategic levers represent different levels of intervention. Enabling services are downstream activities delivered directly to patients, such as screening for social needs, providing transportation assistance, connecting people with food resources, or supporting digital access. Community partnerships operate at a midstream level, linking hospitals with community-based organizations, schools, local agencies, and public health departments. Policy advocacy is an upstream strategy that seeks to influence laws, regulations, reimbursement systems, and public investment. Direct community investment is another upstream approach, in which healthcare organizations commit financial resources, infrastructure, or institutional assets to address the conditions producing poor health. Together, these categories allowed the researchers to distinguish between helping individuals navigate existing barriers and attempting to reduce or remove the barriers themselves.

The second framework describes how organizations conceptualize their responsibilities. Awareness involves identifying patients’ social and digital needs, often through screening, electronic health record documentation, or community health assessments. Assistance means connecting individuals with services or resources. Adjustment refers to modifying clinical practices, communication, or care delivery to accommodate patients’ circumstances. Alignment involves coordinating healthcare organizations with community partners and broader systems. Advocacy describes efforts to influence public policy and structural conditions. The researchers added a sixth category—system governance and accountability—to capture leadership structures, performance measurement, institutional oversight, and mechanisms that make equity an organizational obligation rather than an optional project.

The results reveal a clear imbalance in the current landscape. Enabling services appeared in 86% of the initiatives identified in the literature, making them by far the most common form of equity-oriented action. Community partnerships followed at 70%. By comparison, policy advocacy appeared in 34% of initiatives, while direct community investment was present in only 9%. The pattern suggests that many health systems are willing to help patients manage immediate obstacles, but far fewer are consistently investing in or challenging the systems that create those obstacles. In practical terms, a hospital may help a patient arrange transportation or enroll in a food program, yet stop short of using its political influence or financial resources to address inadequate transit, food insecurity, broadband gaps, or unstable housing at their source.

The responsibility perspectives found in the literature were also multidimensional. Alignment was the most frequently observed perspective, appearing in 83% of the sources or initiatives analyzed. Assistance appeared in 68%, Adjustment in 65%, Awareness in 61%, and system governance and accountability in 60%. Advocacy was least common, appearing in 32%. This ordering suggests that healthcare leaders often see collaboration and coordination as central responsibilities, while direct political engagement remains more difficult to institutionalize. Alignment may include formal partnerships with community-based organizations, referral networks, shared care plans, joint health assessments, and coordinated responses to local needs. However, collaboration alone does not necessarily redistribute power or funding, and the review indicates that partnerships are most effective when supported by governance systems that clarify roles, measure outcomes, and sustain accountability.

The strongest connections between responsibility perspectives and strategic action appeared where organizations were closest to patient care. Assistance and Adjustment were each associated with 98% of enabling-service initiatives, showing that direct support and flexible care delivery tend to develop together. Alignment appeared in every community-partnership initiative and every direct-community-investment initiative, as well as in 83% of enabling-service initiatives. The relationship between Advocacy and upstream work was especially pronounced: Advocacy appeared in 88% of direct-community-investment initiatives, but in only 25% of enabling-service initiatives. System governance and accountability acted as a bridge across all four levers, appearing in 100% of direct-community-investment initiatives, 75% of policy-advocacy initiatives, 56% of community partnerships, and 54% of enabling-service initiatives.

The authors interpret these findings as evidence that U.S. health systems may be approaching an inflection point. Governance and accountability are already present in a substantial share of initiatives, meaning that organizations may possess some of the institutional tools needed to move beyond isolated programs. Those tools can include executive oversight, equity metrics, board-level reporting, community benefit requirements, dedicated budgets, workforce training, and integration of social and digital needs into electronic health records and quality-improvement systems. The challenge is converting recognition into durable organizational behavior. If equity goals are not linked to funding, leadership evaluation, clinical performance measures, and transparent reporting, they can remain vulnerable to changing priorities and short-term grants.

The review also suggests that policy advocacy may be a realistic next step for organizations that have already developed strong partnerships and internal alignment. Healthcare systems are among the largest employers and economic institutions in many communities, giving them potential influence over broadband expansion, housing policy, transportation, food access, Medicaid reimbursement, digital inclusion, and public health funding. Yet the researchers caution, implicitly through the evidence, that upstream responsibility should not replace direct services. Patients facing immediate needs still require practical assistance, while long-term improvements demand coordinated action across healthcare, government, business, education, and community organizations. The emerging model is therefore not a choice between treating individuals and changing systems, but a progression in which patient support, community alignment, governance, investment, and advocacy reinforce one another. As healthcare becomes more digital and health inequities remain deeply connected to social conditions, the study argues that responsibility for health can no longer be limited to what happens inside the examination room.

Subject of Research: Healthcare responsibility for addressing social and digital determinants of health in the United States

Article Title: Leader and organizational stakeholder perspectives on healthcare responsibility for addressing Social and Digital Determinants of Health (SD-DOH) in the United States: a scoping review and qualitative evidence synthesis

Article References: Rangachari, P., Thapa, A., Gari, S. N. B., et al. “Leader and organizational stakeholder perspectives on healthcare responsibility for addressing Social and Digital Determinants of Health (SD-DOH) in the United States: a scoping review and qualitative evidence synthesis.” BMC Public Health (2026).

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29142-x

Keywords: Social determinants of health; Social and digital determinants of health; Health system responsibility; Equity-oriented initiatives; Digital equity; Cross-sector collaboration; Shared accountability; Policy advocacy

Professor Binagwaho, a Rwandan pediatrician of remarkable stature, has dedicated her career to addressing disparities in access to healthcare, underscoring the importance of robust health systems particularly within low- and middle-income countries. She co-founded the University of Global Health Equity (UGHE) in 2015, an innovative institution stemming from Partners In Health’s vision to reimagine health professional education globally. This groundbreaking academic model emphasizes a multidisciplinary approach, integrating clinical excellence with social determinants of health to foster a new generation of healthcare leaders equipped to tackle health inequities worldwide.

Her journey is deeply intertwined with the history of Rwanda’s health transformation. After the 1994 Genocide against the Tutsi, Professor Binagwaho returned in 1996 to assist in the urgent reconstruction of the country’s devastated health infrastructure. Throughout her public service career, spanning from Executive Secretary of the National AIDS Control Commission to Minister of Health, she played a pivotal role in implementing policies that not only controlled infectious diseases like HIV/AIDS but also strengthened healthcare delivery systems at every level, enhancing resilience and equity.

Professor Binagwaho’s leadership extended into global platforms such as co-chairing the Millennium Development Goal Task Force on HIV/AIDS and Access to Essential Medicines, addressing one of the most pressing health challenges of the early 21st century. Her academic influence is further broadened through her appointments at UGHE, Harvard Medical School, and Dartmouth’s Geisel School of Medicine—institutions where she contributes to advancing health equity scholarship and fostering collaboration across diverse health systems.

Her governance roles in prominent organizations including the Rockefeller Foundation, African Europe Foundation, Cummings Foundation, and the African Union Commission for Infectious Diseases Response highlight her global engagement and strategic influence in shaping infectious disease policies and health initiatives. These roles enable her to advocate for equitable health solutions across continents, underscoring the interconnectedness of global health challenges and the need for coordinated responses.

With over 250 peer-reviewed publications to her name, Professor Binagwaho’s scholarly work offers evidence-based insights into strengthening healthcare delivery, particularly in resource-constrained environments. Her recognition by prestigious bodies, including membership in the U.S. National Academy of Medicine and fellowships in both the African Academy of Sciences and the World Academy of Sciences, attests to her standing in the international scientific community. Moreover, her accolades such as being named among the 100 Most Influential African Women and receiving the L’Oréal-UNESCO Award for Women in Science signify the profound impact she has made both scientifically and socially.

Her recent lecture at the RCSI award ceremony delved into the mechanics of “Health Equity and Improving Health Systems,” where she emphasized the indispensable role of community engagement in building trustworthy and resilient healthcare services. Drawing on Rwanda’s experience and broader Sub-Saharan African contexts, she articulated how effective health programs are rooted in authentic community involvement, overcoming mistrust, and demystifying health sciences. This approach aligns with contemporary understandings of health systems as complex adaptive systems requiring stakeholder buy-in and culturally tailored interventions.

The award presentation further illuminated RCSI’s ongoing commitment to advancing the United Nations’ Sustainable Development Goal 3, which aims to ensure healthy lives and promote well-being for all ages. RCSI’s School of Population Health continues to expand research that tackles diverse population health challenges ranging from non-communicable diseases like diabetes to environmental factors such as air pollution. This dedication to locally relevant yet globally applicable research strategies reflects the enduring legacy of Sir Charles A. Cameron, whose reforms laid the groundwork for integrated public health.

Professor Cathal Kelly, Vice Chancellor of RCSI, lauded Professor Binagwaho’s embodiment of the equity, compassion, and collaboration at the heart of the Cameron Award. He noted that her visionary leadership in reconstructing Rwanda’s health system and fostering health professional education serves as a compelling model for institutions worldwide committed to health equity. Such leadership is crucial in today’s global health landscape, marked by complex systemic inequities and emergent health threats requiring innovative, inclusive solutions.

RCSI itself remains a frontrunner in medical education and research with a focus on global health impact, as demonstrated by its top-ranking in the Times Higher Education University Impact Rankings 2025 for contributions to SDG 3. The institution’s international outlook is matched by initiatives such as a forthcoming public engagement center in Dublin, designed to bridge scientific discovery and public understanding. This space aims to catalyze health literacy and empower individuals with the knowledge to make informed health choices, reflecting RCSI’s philosophy of community partnership and knowledge dissemination.

In sum, Professor Agnes Binagwaho’s receipt of the Cameron Award underscores a life’s work devoted to systemic improvements in population health through health equity, education, and community-driven healthcare transformation. Her career narrative illustrates the power of integrating clinical expertise, policy leadership, and academic rigor with social justice imperatives, setting a benchmark for global health stewardship in the 21st century. Her example inspires continued efforts to forge resilient health systems that leave no one behind, echoing the foundational values exemplified by Sir Charles A. Cameron over 150 years ago.

Subject of Research: Health equity, health systems strengthening, and global health education in low- and middle-income countries.

Article Title: Professor Agnes Binagwaho Awarded the Cameron Award for Population Health by RCSI

News Publication Date: 3 November 2025

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Keywords: Health Equity, Global Health, Public Health Leadership, Health Systems Strengthening, Medical Education, Rwanda, Infectious Diseases, Community Engagement, Sustainable Development Goals, Population Health, Universal Health Coverage, Health Policy

At the heart of this initiative lies the conviction that health is a universal right. Dr. John Rich, the Harrison I. Steans Director of the RUSH BMO Institute for Health Equity, articulates this belief emphatically: “We believe everyone should have the chance to be healthy.” However, he acknowledges the harsh reality evidenced in medical literature — that marginalized groups often experience barriers in accessing adequate healthcare services. The primary objective of this new platform is to analyze the underlying factors contributing to these disparities, thereby empowering healthcare providers and researchers to enact meaningful change.

The envisioned data warehouse will be a comprehensive repository, aggregating a wide range of health informatics, real-time data sourced from home health devices, and personal testimonies from patients themselves. This multifaceted approach is designed to shed light on the “hot zones” in Chicago where chronic diseases predominantly manifest. By tapping into diverse data sources, researchers will have the ability to pinpoint these critical areas and implement targeted interventions to promote health equity.

Furthermore, the establishment of this data commons enables researchers to create a secure environment to experiment with innovative technologies — particularly artificial intelligence. The insights gained from this data will be crucial in crafting algorithms that accurately reflect the real-world scenarios in which healthcare issues arise. Jeff Gautney, the senior vice president and chief information officer at Rush, emphasizes the potential of this data-driven methodology, describing the ability to mobilize clinical data as the “key ‘superpower’” essential for unlocking the vast potential of AI in healthcare.

To delve deeper into the multifactorial nature of health inequities, this initiative will take into account a variety of determinants of health, which include not only medical histories but also social and physical environmental factors. This holistic view allows for a comprehensive understanding of how various elements intersect to produce disparities in health outcomes. For instance, the initiative aims to build upon existing frameworks like remote blood pressure monitoring to gather richer, contextualized data on community health.

Dr. Juan C. Rojas, a key figure in guiding this project, articulates the importance of respecting patient privacy while utilizing data to identify prevalent chronic conditions among specific demographic groups. His vision aligns with Rush’s commitment to fostering collaboration across Chicago’s healthcare systems to close the gaps that exist for patients with chronic diseases, ultimately aiming to extend life expectancy among disadvantaged populations.

Chicago has long grappled with substantial disparities in life expectancy, often attributed to chronic ailments such as cardiovascular diseases. Dr. Rojas notes the importance of granular data collection to tackle these issues effectively. Currently, citywide health assessments rely heavily on survey responses, which can only provide a limited glimpse into the realities faced by various communities. The new data warehouse promises to furnish more precise and actionable data that healthcare providers can utilize to understand the health concerns that affect census tracts more intimately.

The comprehensive nature of this project underlines the need for a data convergence that synthesizes disparate health data streams into coherent insights. Dr. Rich emphasizes a common misconception: that individual behaviors solely account for health problems faced within marginalized communities. Instead, he argues that a deeper exploration into data can reveal fundamental systemic issues that contribute to the observed disparities, paving the way for innovative solutions that break down silos between different healthcare institutions.

The collaborative ethos of this initiative extends beyond data collection and analysis. Rush is committed to fostering authentic partnerships with the communities most affected by health inequities. By creating meaningful data visualizations, the organization aims to present complex health information in a manner that transcends traditional graphs and charts. These visual tools are designed not just to inform healthcare professionals but to engage and empower community members as active participants in the dialogue surrounding their health.

This extensive endeavor represents a vital component of Rush’s broader mission to address healthcare inequities. The transformative potential of this initiative is evident in how it seeks to incorporate technology, community insights, and rigorous research methodologies to create interventions that are targeted and effective. As such, it stands as a paradigm for other healthcare systems striving to reconcile the disparities that persist across their communities.

Philanthropic contributions, like those from the Searle Funds, illustrate the growing recognition of the necessity for coordinated efforts to overcome the challenges faced by urban health systems. This effort aligns with Rush’s overarching objectives under the RUSH Campaign, which aims to mobilize resources towards creating a health system that innovatively serves all community members. By focusing on health equity, innovation, and education, Rush endeavors to craft a future where systemic barriers in healthcare can be dismantled and restructured to promote improved health outcomes for all.

As this promising project unfolds, it serves as a beacon of hope not only for Chicagoans but also for communities grappling with similar health disparities elsewhere. The integration of multifaceted data analytics, combined with community participation and stakeholder engagement, lays the groundwork for an equitable healthcare paradigm that prioritizes population health. Ultimately, the initiative exemplifies a synergistic approach to health equity that could become a model for health systems across the nation.

This innovative data platform by Rush University Medical Center represents a significant leap forward in harnessing the power of data to combat health inequities in Chicago. By creating a robust infrastructure that is capable of informing thoughtful interventions and engaging community members meaningfully, Rush is poised to lead a new era of healthcare that addresses the root causes of chronic diseases and their associated disparities.

Subject of Research: Health Equity and Data Analytics
Article Title: Rush University Medical Center Launches Innovative Data Platform to Tackle Health Inequalities in Chicago
News Publication Date: October 2023
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Keywords: Health equity, data analytics, chronic diseases, Chicago, Rush University Medical Center, artificial intelligence, community health, healthcare disparities, philanthropy, public health, data infrastructure, healthcare innovation.