Policy makers, farm family advocates, and researchers have overall focused on resolving issues connected to the farm operation such as access to land or farm transition. The consideration of household level issues, such as difficulties paying for health insurance or saving for retirement, has however been inadequate despite the evidence that these difficulties can negatively impact the development and viability of the farm operation. To work towards a greater understanding of the factors that shape and support family farms, I explore the links between farm household social needs, social policy, and farm persistence in three stand-alone, yet, connected research articles. The farm persistence literature, a body of work with a long tradition of studying how family farms adapt to on-going changes, provides the theoretical foundation of this dissertation. My methodological approach is based on a mix of qualitative and quantitative data and a comparative approach. In the first article, I broadly consider the role of social policy in the farm sector and propose a research framework to integrate social policy into the international family farm research agenda. Then, I focus on health policy, a large component of social policy in Western industrialized countries, and health needs, a major social need, for U.S. farm households as an empirical case. In particular, I assess U.S. farm households’ access to health insurance and health care along the life course in the second article and I assess their medical economic vulnerability in the third article.Taken together, my findings point to difficulties accessing and paying for health insurance and health care and a general sense of vulnerability. Farm households of all ages juggle trade-offs between household consumption, savings, and on-farm investments but it is the younger households that are the most vulnerable despite being in better health. Meanwhile, the eligibility for old-age universal coverage (i.e. Medicare) does not remove all difficulties and bring up questions about the impact of social needs on the timing and cost of farm transition. While having public health insurance eases access to care, the buffer that it provides in case of major illness or injury is limited. More important than the sole availability of social safety net programs, my findings point to the importance of considering both the institutional arrangements of these programs and farm households’ lived experiences accessing these programs. Theoretical contributions to the family farm literature relevant broadly to Western industrialized countries include the expansion and reframing of our understanding of the factors that shape the development of farm operations and farm reproduction by bringing households level difficulties and social policies to the forefront. My dissertation also provides insights on the importance of embracing the complexity of farming system through a relational approach and the consideration of lived-experiences. Practical implications include the need to account for household level issues in programs and policies aimed at supporting the agricultural sector as well as the need to consider the extent to which social policies could support both the farm household and the operation. I conclude this dissertation by highlighting avenues for future research. Cross-national comparative research would provide important insights towards understanding the mechanics of social safety net programs, the ways farm households interact with these programs, and the type of programs that support them the most. There is also a need to further explore the interactions between social needs, social policy, and farm persistence including the linkages across multiple social needs along the life course. Longitudinal data are essential to assess compounding effects of the difficulties meeting social needs on the well-being and health of farm households and on the long-term viability of farm operations. Last, because my findings point to the importance of institutional arrangements, it is crucial to continuously update the family farm literature to reflect the on-going changes in the political, economic, and social spheres.