LAUSR

H ealth follows a social gradient. As health care delivery systems take on increased responsibility for overall health and well-being, they must unravel the complex relationship between social determinants of health and health outcomes. For our modern care delivery systems, new ways of thinking about social innovation are required, drawn from outside the traditional health care playbook. Community-based health issues have distinct characteristics that must be well-understood to advance effective solutions. The underlying population health issues being addressed often have multiple root causes that must be considered both separately and together in addressing a workable solution to improve population health. Given this, the interventions designed are typically multifaceted with numerous touchpoints within the targeted population. This requires the engagement and alliance of multiple stakeholders—government, community-based, and private organizations—responsible for delivering services. Benefits of such work accrue both publicly and privately requiring proper alignment to maintain stakeholder engagement and to sustain the program. Bringing people together in structured ways to achieve social change, often referred to as “collective impact,” provides health care delivery systems with a framework for tackling complex, public health problems. Recent initiatives that highlight the use of a collective impact approach include the “Communities That Care,” a prevention system designed to address youth behavior problems and the Centers for Medicaid & Medicare and the “Accountable Health Communities Model,” designed to address the effects of social determinants of health on health and well-being, health care outcomes, and health care costs in federally insured populations. Such programs highlight the importance of coalition building with key stakehold-