How Trauma-Informed Programming to Treat Social Determinants Unveils Challenges to Systems Alignment.

Cross-sector collaboration and systems alignment to promote a culture of health can address social determinants of health (SDH), improve family well-being, and create a more equitable society. This paper documents our attempt to align Temporary Assistance for Needy Families (TANF) and Medicaid to promote health through a trauma-informed program, The Building Wealth and Health Network (The Network). The Network successfully integrated into traditional TANF and addresses SDH through peer-group programming where caregivers heal from adversity and build financial skills. We identify three challenges to alignment of TANF and Medicaid: 1) TANF's culture of compliance, 2) societal and systems-level forces including racism and discrimination, 3) misaligned partnerships (values, priorities, structure, and capability). For each challenge, we propose solutions including incentives for innovation and partnership, and promotion of racial equity initiatives, including reparations. By highlighting challenges and solutions we seek to strengthen current approaches to achieve health equity through systems alignment.

Financial health as a measurable social determinant of health.

OBJECTIVES: Financial health, understood as one's ability to manage expenses, prepare for and recover from financial shocks, have minimal debt, and ability to build wealth, underlies all facets of daily living such as securing food and paying for housing, yet there is inconsistency in measurement and definition of this critical concept. Most social determinants research and interventions focus on siloed solutions (housing, food, utilities) rather than on a root solution such as financial health. In light of the paucity of public health research on financial health, particularly among low-income populations, this study seeks to: 1) introduce the construct of financial health into the domain of public health as a useful root term that underlies other individual measures of economic hardship and 2) demonstrate through outcomes on financial, physical and mental health among low-income caregivers of young children that the construct of financial health belongs in the canon of social determinants of health. MATERIALS AND METHODS: In order to extract features of financial health relevant to overall well-being, principal components analysis were used to assess survey data on banking and personal finances among caregivers of young children who participate in public assistance. Then, a series of logistic regressions were utilized to examine the relationship between components of financial health, depression and self-rated health. RESULTS: Components aligned with other measures of financial health in the literature, and there were strong associations between financial health and health outcomes. PRACTICE IMPLICATIONS: Financial health can be conceived of and measured as a key social determinant of health.