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Why Focus on the Social Determinants of Health?

Social Determinants of Health (SDOH) are also known as Health-related Social Needs.

When we understand the impact of health-related social needs, we understand their primacy in health equity work.

In 1946 the World Health Organization’s constitution declared that “the highest standards of health should be within reach of all, without distinction of race, religion, political belief, economic or social condition”. This is just one example of how long we have recognized health inequities and their relationship to social factors. Without a doubt, the road to health equity has been a long one, but we have learned much along the way.

Healthy People 2030 defines health equity as "the attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”

Over time we have also identified the social factors that impact health most significantly. Healthy People 2030 defines these Social Determinants of Health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Addressing the SDOH has become an important path to achieving health equity.

The SDOH fall under 5 domains:

· Economic Stability

· Education Access and Quality

· Health Care Access and Quality

· Neighborhood and Built Environment

· Social and Community Context

Economic Stability looks at a person’s capacity to afford stable housing, health-promoting food, healthcare, and other basic necessities. Evidence shows that poor health can result in poverty and poverty can result in poor health. This bidirectional relationship between poverty and health makes economic stability a high priority target for those who seek to achieve health equity.

Individuals who live in poverty are more likely to:

  • Miss medical appointments

  • Stop taking necessary medications

  • Be hospitalized for exacerbations of chronic conditions

Education Access and Quality highlights the relationship between education and health. This includes the importance of general literacy (ability to read, write and do math) as well as health literacy (the ability to understand and use health-related information).

According to the CDC, individuals with less education are more likely to experience:

  • Obesity

  • Substance abuse

  • Intentional and unintentional injuries

Health Care Access and Quality has to do with the ability to receive the right care, in the right place, at the right time, from the right provider, in the right way. It is important to remember that health care access is not the same thing as healthcare availability. While care services may be available, being able to connect with those services in a way that is meaningful can be impacted by things like lack of providers that are culturally congruent, as well as negative experiences with the healthcare system.

The Agency for Healthcare Research and Quality (AHRQ) reports that when individuals receive care from culturally congruent providers, who look like them and can relate culturally to them, they are more likely to see improved health outcomes including:

  • Improved mental health (less depression and substance use)

  • Reduction in obesity,

  • Less kidney disease

  • Less heart disease

  • Better breast cancer outcomes

  • Better sickle cell disease outcomes

Neighborhood and Built Environment acknowledges that the characteristics of a neighborhood, from the presence of crosswalks and grocery stores, to access to green space and whether the water and air are clean, can make the difference between positive and negative health outcomes.

Neighborhoods that have more sources of emissions including those with higher motor vehicle movement and pollution-causing industries, which are generally the same neighborhoods were racial/ethnic minorities live, are more likely to see higher levels of:

  • Emphysema

  • Asthma

  • Chronic obstructive pulmonary disease (COPD)

  • Developmental health issues among children

Social and Community Context has to do with the impact of social factors such as violence, trauma, racism, discrimination, disenfranchisement, and underrepresentation on health.

The Adverse Childhood Experiences (ACEs) study conducted by the CDC and Kaiser Permanente, demonstrates that children who experience higher levels of trauma grow up to have a higher incidence of:

  • Traumatic brain injuries

  • Depression, anxiety, suicide, PTSD

  • Unintended pregnancy and pregnancy complications (fetal death)

  • HIV and other STDs

  • Cancer

  • Diabetes

  • Alcohol and drug abuse

Once we understand the impact of the SDOH and their association with health disparities, it is incumbent on all who work in healthcare to assess every patient for the presence of these determinants, to document them, and to connect patients with the resources they need so they can thrive and not just survive.


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