Population Health

Social Determinants of Health

“Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.” – Healthy People 2020

AACHC supports efforts on behalf of our Community Health Centers and partners to collect information on and address Social Determinants of Health (SDOH) in the patients we serve.

One way we do this is through PRAPARE – Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences, a tool developed by our National Association (NACHC) to help health centers and other providers collect and apply data to better understand SDOH.

PRAPARE Implementation and Action Toolkit (updated March 2019)

PRAPARE Assessment Tool, including translation into 10 languages for patients

PRAPARE Meeting 6/25/2019

For more information on PRAPARE, please contact Emily at emilyo@aachc.org, Shelli at shellir@aachc.org, or Jessica at jessicay@aachc.org.

Addressing Population Health through Special Populations

HRSA Funded Special Populations

AACHC supports efforts to reach out to federally-designated special populations, which include migrant and seasonal agricultural workers, individuals and families experiencing homelessness, and those living in public housing. Some health centers receive additional funding to focus on ensuring these groups receive health services. Click on the links below to learn more about these special populations.

Other Special Populations

In addition, there are other special populations currently being served by health centers, and AACHC will support efforts to best serve these populations as well, which include gender and sexual minorities (GSM includes LGBTQ), elderly, veterans, persons living with HIV/AIDS, and school-based populations. If there are any other special populations in the state that may need specific considerations, please let us know, and we will do our best to find resources to help you better serve these populations.

Additional Cooperative Agreements/Resources


Language Access


In partnership with the Arizona Department of Health Services Health Disparities Center, we have developed materials to make it easier for Limited English Proficiency patients to identify their language to providers, as well as make providers and patients aware of the patients’ rights.

Updated in 2018 with Navajo, Japanese, German, and Assyrian.

Please visit this link to access “I Speak” cards, fact sheets, and a list of languages that providers can use.

Snapshot of some of AACHC’s activities in 2018:


Please contact Emily at emilyo@aachc.org with any questions regarding special populations.