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Rural Health Information Hub

Rural Health
Resources by Topic: Social determinants of health

Accountable Health Communities Model
Provides information on the Centers for Medicare & Medicaid Services (CMS) Innovation Center's Accountable Health Communities Model, which tested whether systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services would impact healthcare costs and reduce healthcare utilization. Aimed to link beneficiaries with community services that may address their health-related social needs.
Type: Website
Sponsoring organization: Centers for Medicare and Medicaid Services
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Wisconsin Equitable Program Development Dashboard
An interactive data map of Wisconsin that provides information on socioeconomic factors and community-based assets. Includes census tract, county subdivision, and block group-level data on the social determinants of health, such as education, income, housing, race/ethnicity, language, location of hospitals, and location of retailers accepting FoodShare.
Type: Map/Mapping System
Sponsoring organization: University of Wisconsin Cooperative Extension
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The Wisconsin Risk and Reach Project
An interactive dashboard that provides information about potential risks to children in Wisconsin and programs that can mitigate risks. Allows user to search by risk variables such as economics, education, and health and safety, as well as available programs and county.
Type: Website
Sponsoring organizations: Applied Population Laboratory, Wisconsin Department of Children and Families, Wisconsin Department of Health Services
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The Arizona Social Vulnerability Index (ASVI)
Adapts the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Diseases Registry's Social Vulnerability Index (SVI) to include factors specific to Arizona. Includes interactive data at the census tract level covering social determinants of health, household characteristics, race and ethnicity, housing, transportation, and more.
Type: Website
Sponsoring organization: Arizona Department of Health Services
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Health Equity Advancement/High-Need Mapping Tool
Interactive map highlighting various social determinants of health indices with Health Resources & Services Administration (HRSA) Health Center and grants data. Data can be viewed by HRSA Region, state, or county.
Type: Map/Mapping System
Sponsoring organization: Health Resources and Services Administration
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Rural Health Insights for Each State & Congressional District
Provides access to state and congressional district data on healthcare infrastructure, healthcare workforce by profession, health outcomes, and social determinants of health.
Type: Website
Sponsoring organizations: National Organization of State Offices of Rural Health, National Rural Health Association, Stroudwater Associates
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North Carolina Behavioral Risk Factor Surveillance System (BRFSS): Calendar Year 2022 Results
Provides survey data on health behaviors and health status in North Carolina for the year 2022. Covers access to care, wellness, nutrition, chronic conditions, tobacco use, cancer screening and survivorship, COVID-19, disability, race and ethnicity, and more. Includes breakdowns by urban/suburban/rural county.
Type: Website
Sponsoring organization: North Carolina Department of Health and Human Services
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Neighborhoods at Risk
Tool offering maps and reports of neighborhoods by environmental risks and disparities in impact. Data available at the census tract, city, county, or state level.
Type: Tool
Sponsoring organization: Headwaters Economics
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Populations at Risk
Tool offering downloadable socioeconomic reports covering age, race and ethnicity, educational attainment, language proficiency, poverty, assistance programs, employment, and housing. Includes ability to compare locations by census tract, city, county, state, tribal, metropolitan, and nonmetropolitan areas.
Type: Tool
Sponsoring organization: Headwaters Economics
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Pathways to Equity Rural Health Roadmap
Outlines a roadmap for rural health organizations to improve health equity in their communities. Includes guidance on building trust, forming a health equity team, assessing health risks, developing strategies and collaborations, and taking action.
Type: Document
Sponsoring organization: Pathways to Public Health Equity
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