By Dr. Sarah DeSilvey and Dr. Patricia Welch Saleeby | April 2026
When we talk about health, we usually focus on what happens inside a doctor’s office. But as any public health expert will tell you, our health and well-being are shaped long before we enter that office. “Social Determinants of Health” (SDOH) account for the vast majority of our health outcomes—far more than clinical care alone. According to the World Health Organization (2025), SDOH are the conditions in which we are born, grow, live, work, and age. From the food we consume to the air we breathe to the stability of the roof over our heads, our environment shapes our health and well-being.
At the heart of these determinants is economic stability – factors like income, socioeconomic status, and wealth — that influence poverty, food insecurity, housing instability, and other challenges that shape health outcomes. In fact, economic stability is one of the five key pillars, along with education access and quality; health care access and quality; neighborhood and built environment; and social and community context.
Why Baby Bonds Matter for Public Health
Let’s take Baby Bonds — a bold economic intervention created by Institute Founding Director Darrick Hamilton, designed to break the cycle of intergenerational poverty. What’s exciting to a growing number of health and social care experts is that, by extension, Baby Bonds may also help improve the health of our nation.
We know that wealth is one of the strongest predictors of life expectancy. By narrowing the racial and economic wealth gap, Baby Bonds directly addresses the systemic health disparities that have persisted for generations. Wealth grants agency—and agency expands healthy choices. It allows families to choose safer housing, afford nutritious food, and prioritize preventative screenings rather than waiting for a medical crisis to strike.
Furthermore, living in a state of constant financial “survival mode” triggers chronic stress hormones that damage the heart and immune system over time. By providing a forward-looking foundation for economic security, Baby Bonds protect against the cumulative physical and mental toll brought on by years and years of financial stress.
When we provide children from low-wealth families with a publicly funded trust at birth, we aren’t just building their bank accounts; we are increasing their generational security, health, and vitality.
Gravity Project Standardizing the Language of Health Equity
Capturing the true impact of these external factors requires moving data out of silos and into a unified view. SDOH data often lives in social service agencies or schools, while health data lives in the Electronic Medical Record (EMR). What’s known as “health interoperability” provides the critical digital infrastructure needed to bridge the gap between clinical records and community-level data. Interoperability using standards like Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) allows these systems to communicate with one another. In practice, this enables providers to accurately identify, track, and address these SDOH in real-time.
While wealth and health are intrinsically linked, health care systems have lacked a uniform way to document these “non-clinical” factors in a patient’s record. The Gravity Project is addressing this limitation. As a national, multi-stakeholder collaborative, Gravity Project develops consensus-driven data standards for SDOH. By creating specific codes for factors such as financial insecurity and material hardship—and for evidence-based interventions such as Baby Bonds, diaper programs, and the Earned Income Tax Credit— The Gravity Project ensures that a person’s economic reality is as visible to their care team as their blood pressure or cholesterol levels.
A New Health Infrastructure: Mapping Economic Resilience in the Clinical Setting
Integrating an economic intervention like Baby Bonds into the data standards of the Gravity Project creates a powerful feedback loop for public health care systems. Standardized SDOH data allows providers to identify families facing the highest financial risks – many of whom stand to benefit most from wealth-building programs. Thus, the Gravity Project’s technical work allows various system providers, including pediatricians, nurse practitioners, and social workers, to speak the same language. This ensures that when a social risk like poverty is identified, a social intervention—such as a wealth-building program like Baby Bonds—can be part of the family’s care plan.
Using Gravity’s standards will allow policymakers and researchers to accurately track how an influx of future wealth, like a Baby Bond, affects a child’s health trajectory over time, an important step in building the evidence for these policies.
By embedding economic interventions directly into the clinical workflow, we will finally be able to move beyond basic data collection toward proactive and predictive models of care. The standardized approach to interoperability ensures that wealth-building tools like Baby Bonds are no longer isolated social experiments but rather integrated components of a broader health and economic strategy. This will create a future where a child’s health trajectory is defined not by the financial limitations of their birth, but by the integrated support systems designed to support their long-term economic and physical well-being.
As practitioners in their respective fields of nursing and social work, Drs. Sarah DeSilvey and Patricia Welch Saleeby know a lot about social determinants of health. They have lived it.
Informed by decades of experience, they are working to transform abstract social challenges into actionable clinical data. As a founder and now Terminology Director at Gravity Project, Dr. DeSilvey has helped to standardize medical terminology to ensure that when a patient reports food or housing instability, it is coded with the same precision as a diagnostic test. This is supported by her current practice as a rural primary care provider.
Dr. Saleeby is the Social Work Program Director at Bradley University. She is the International Classification of Functioning, Disability and Health (ICF) content expert for the PACIO Project, community member at Gravity Project, and Co-Chair of the Functioning and Disability Reference Group for the World Health Organization. She contributed to the development of the ICF, which provides a holistic framework to document a patient’s functional lived experience, including personal and environmental codes. Together, these standards are building the lexicon of interoperability and defining the future of global public health.