Letter to the ICD-10-CM Coordination and Maintenance Committee

On November 11, 2021, Children’s HealthWatch submitted a letter to the ICD-10-CM Coordination and Maintenance Committee in support of the Gravity Project Multi-Domain Social Determinants of Health ICD-10-CM Application.

Children’s HealthWatch seeks to improve the health and development of young children and their families by informing equitable policies that address and alleviate economic hardships and dismantling systems of institutionalized discrimination and inequity at the root of these hardships. Our work begins with research interviewing caregivers of young children on the frontlines of pediatric care in urban emergency departments and primary care clinics in five cities: Boston, Minneapolis, Little Rock, Baltimore, and Philadelphia. Over two decades of research at Children’s HealthWatch has consistently shown that improving the health and well-being of children and families requires robust resources and supports across multiple social determinants of health (SDOH) domains, including housing, nutrition, child care, utilities, and health care. We know that children and families do not live in siloes. Identifying and addressing these social needs is critical to adequately responding to the realities of children’s lives and ensuring that all children have equal opportunities to thrive.

Over the past two years, Children’s HealthWatch has been an active participant in the Gravity Project. This national public collaborative is developing consensus-based data standards to help reduce current barriers for documenting and exchanging SDOH data within health care and other sectors. Experts have long known that social and environmental determinants of health contribute significantly to a person’s and a population’s health status. Our research has consistently shown that when families with children do not have access to basic needs – including housing, food, utilities, and child care – their health suffers.1,2,3,4 Despite this knowledge, limitations in existing clinical terminologies and vocabularies complicate our ability to define the needs of patients, share care with social agencies and community organizations, represent social risk in claims, and measure quality. There is a clear need to refine and augment existing SDOH data carefully. The surrounding COVID-19 pandemic and twin economic strain have made this work ever more pressing. Since May 2019, the Gravity Project has convened critical stakeholders to develop evidenced-based and risk-informed diagnostic language in both ICD-10-CM and SNOMED-CT for core social determinants of health.