Social determinants of health shape our well-being from birth to old age. They include where we live, work, and play, as well as our education, income, and access to healthcare. These factors often have a bigger impact on health than medical care or personal choices.

Understanding social determinants is key to tackling health inequities. By addressing issues like poverty, discrimination, and lack of education, we can create fairer health outcomes for all. This approach recognizes that health is influenced by more than just individual behaviors.

Social Determinants of Health

Defining Social Determinants of Health

• The social determinants of health (SDOH) are 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
• Key social determinants include socioeconomic status, education, neighborhood and physical environment, employment, social support networks, and access to health care (housing, transportation)
• Social determinants can be more important than health care or lifestyle choices in influencing health, and they interact with other determinants to produce health outcomes
• Healthy People 2030, released by the U.S. Department of Health and Human Services, provides a framework for addressing SDOH through setting data-driven national objectives to improve health and well-being over the next decade

Importance of Social Determinants

• SDOH shape health outcomes across the lifespan, from prenatal development through childhood, adolescence, adulthood, and older age
• Addressing SDOH is crucial for improving population health and reducing health disparities, as they are the root causes of many health inequities
• The impact of SDOH can accumulate over time, leading to widening health gaps between advantaged and disadvantaged populations
• Interventions targeting SDOH have the potential for broad and sustained improvements in health outcomes and health equity

Social Factors and Health Inequities

Health Inequities and Affected Populations

• Health inequities are systematic differences in the health status of different population groups, often resulting from the social conditions in which people are born, grow, live, work, and age
• Populations experiencing health inequities may include racial and ethnic minorities, residents of rural areas, women, children, the elderly, persons with disabilities, and the LGBTQ community (African Americans, Hispanics, Native Americans)
• Health inequities are unjust and avoidable, reflecting an unfair distribution of health risks and resources across society
• Measuring health inequities involves comparing health outcomes and determinants across population groups and assessing the magnitude of disparities

Social Factors Contributing to Health Inequities

• Social factors such as discrimination, social exclusion, poor access to health care, inadequate education, and poverty can contribute to health inequities by limiting access to resources and opportunities for health
• Discrimination based on race, ethnicity, gender, sexual orientation, disability status, or other characteristics can lead to chronic stress, unhealthy behaviors, and reduced access to health-promoting resources (employment, housing)
• Social exclusion, or the lack of participation in mainstream social, economic, and cultural activities, can limit access to social support, information, and services that promote health
• The concepts of health equity and social determinants of health are intertwined, as addressing SDOH is a primary approach to achieving health equity

Socioeconomic Factors and Health Disparities

Impact of Socioeconomic Status

• Socioeconomic status (SES), typically measured by income, education, or occupation, is among the most powerful predictors of health outcomes
• Lower SES is associated with higher mortality rates for many causes of death, higher prevalence of health risk behaviors, and decreased access to health care and preventive services (cardiovascular disease, diabetes, smoking)
• The relationship between SES and health is graded, with health improving at each step up the socioeconomic ladder
• SES affects health through multiple pathways, including material resources, psychosocial factors, health behaviors, and access to health care

Role of Education and Access to Healthcare

• Educational attainment is linked with health through three major interrelated pathways: health knowledge and behaviors, employment and income, and social and psychological factors
• Higher levels of education are associated with better health outcomes, including longer life expectancy, lower rates of chronic diseases, and better self-reported health status
• Inadequate access to health care, influenced by lack of insurance coverage, lack of a usual source of care, and barriers such as transportation, contributes to poorer health status and health disparities
• Limited access to preventive services, screening, and early treatment can lead to delayed diagnoses, more severe illness, and higher mortality rates (cancer, HIV/AIDS)

Social Policies for Health Equity

Types of Social Policies

• Social policies are public policies that affect the well-being of society, including economic support, education, health care, housing, and other forms of social welfare
• Policies that address poverty, early childhood education, affordable housing, and access to health care can have a significant impact on improving population health and reducing health inequities (earned income tax credit, Head Start, Housing Choice Vouchers)
• Place-based initiatives target specific neighborhoods or communities to improve living conditions and health through a multi-sectoral approach addressing various social determinants (Promise Neighborhoods, Choice Neighborhoods)
• Health-in-all-policies is an approach that systematically considers the health implications of social policies across sectors to improve population health and health equity

Evaluation and Implementation of Social Policies

• Evaluation of social policies is important to determine their impact on SDOH and health equity, as well as any unintended consequences
• Rigorous evaluation designs, such as randomized controlled trials or natural experiments, can provide strong evidence of policy effectiveness
• Implementation science focuses on understanding how to effectively translate evidence-based interventions into real-world settings and diverse populations
• Engaging communities in the development, implementation, and evaluation of social policies can ensure that they are responsive to local needs and priorities (community-based participatory research)