Social determinants of health shape our lives and health outcomes from birth. These non-medical factors, like income, education, and environment, drive health inequities between different groups. Understanding their impact is key to improving public health and achieving fairness.

Addressing social determinants requires teamwork across sectors and community involvement. By tackling root causes like poverty and discrimination, we can reduce health gaps and boost overall well-being. It's about creating environments where everyone has a fair shot at good health.

Social Determinants of Health

Definition and Role in Population Health

• 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
  • Encompass economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context
  • These non-medical factors influence health outcomes and are the primary drivers of health inequities, which are the unfair and avoidable differences in health status seen within and between populations (racial/ethnic minorities, low-income populations)
• Addressing SDOH is a primary approach to achieving health equity and improving population health outcomes
  • Involves policies and interventions that target the underlying social, economic, and environmental conditions that shape health
  • Requires collaboration across sectors (healthcare, education, housing, transportation) and engagement of communities in decision-making processes
• The social ecological model provides a framework for understanding the interplay of individual, relationship, community, and societal factors that influence health behaviors and outcomes
  • Individual level includes biological and personal factors (age, gender, health behaviors)
  • Interpersonal level includes social networks and support systems (family, friends, peers)
  • Community level includes the settings where social relationships occur (schools, workplaces, neighborhoods)
  • Societal level includes the broader social, economic, and cultural norms and policies that shape the other levels

Impact on Health Inequities

• Health inequities are the systematic and unjust differences in health outcomes and opportunities between different population groups
  • Shaped by the distribution of money, power, and resources at global, national, and local levels
  • Influenced by factors such as race/ethnicity, socioeconomic status, gender, sexual orientation, and disability status
• Addressing SDOH is essential for reducing health inequities and promoting health equity
  • Requires targeting interventions and resources to the populations and communities most affected by health disparities
  • Involves addressing the root causes of inequities, such as racism, discrimination, and poverty, through policies and systems change
  • Emphasizes the importance of community engagement and empowerment in identifying and addressing health priorities

Socioeconomic Factors and Health Disparities

Socioeconomic Status and Health

• Socioeconomic status (SES), which includes income, education, and occupation, is a key determinant of health
  • Lower SES is associated with higher rates of chronic diseases (heart disease, diabetes), mental health problems (depression, anxiety), and mortality
  • SES influences health through various pathways, including access to resources, exposure to stressors, and health behaviors
• Income inequality, which is the uneven distribution of income across a population, is linked to poorer health outcomes and higher mortality rates, even in high-income countries
  • Greater income inequality is associated with lower life expectancy, higher rates of infant mortality, and greater prevalence of mental illness
  • Income inequality may affect health through mechanisms such as reduced social cohesion, increased stress, and limited access to health-promoting resources

Education and Health Disparities

• Educational attainment is strongly associated with health outcomes, with higher levels of education correlating with better health and longer life expectancy
  • Education influences health literacy, which is the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions
  • Higher education is associated with healthier behaviors (regular exercise, healthy diet), better access to healthcare, and greater social and economic opportunities
• Disparities in educational opportunities and quality contribute to health disparities
  • Low-income and minority communities often have lower-quality schools and fewer educational resources
  • Early childhood education and development programs (Head Start) can improve educational outcomes and long-term health

Environmental Factors and Health

• Environmental factors, such as air and water quality, housing conditions, and access to healthy food and green spaces, play a significant role in health disparities
  • Disadvantaged communities often face disproportionate exposure to environmental hazards (pollution, toxins, noise)
  • Poor housing conditions (overcrowding, mold, pests) are associated with respiratory illnesses, injuries, and mental health problems
• Residential segregation, which is the separation of racial or ethnic groups in a geographic area, contributes to health disparities by shaping access to resources, opportunities, and exposures to health risks
  • Segregated neighborhoods often have fewer health-promoting resources (healthcare facilities, parks, healthy food options) and greater exposure to health risks (crime, violence, environmental hazards)
  • Policies and practices such as redlining and discriminatory lending have contributed to residential segregation and health disparities

Social Factors and Chronic Diseases

Stress and Chronic Disease

• Chronic diseases, such as heart disease, diabetes, and cancer, are the leading causes of death and disability worldwide
  • Social factors significantly influence the development and management of these conditions
  • Addressing social determinants is crucial for preventing and controlling chronic diseases
• Stress, particularly chronic stress related to social and economic disadvantage, can lead to physiological changes that increase the risk of chronic diseases
  • Chronic stress activates the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, leading to elevated cortisol and inflammation
  • The allostatic load model explains how cumulative stress exposure affects health by wearing down the body's adaptive systems
• Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are associated with increased risk of chronic diseases in adulthood
  • The ACE study demonstrated the dose-response relationship between ACEs and health outcomes, with higher ACE scores correlating with greater risk of conditions such as heart disease, stroke, and diabetes
  • ACEs may influence chronic disease risk through biological mechanisms (altered stress response, immune dysfunction) and behavioral pathways (smoking, substance abuse)

Social Isolation and Health Behaviors

• Social isolation and loneliness, which are more prevalent among disadvantaged populations, are linked to increased risk of chronic diseases and mortality
  • Lack of social connections and support can lead to physiological changes (increased inflammation, impaired immune function) and unhealthy behaviors (smoking, physical inactivity)
  • Social support can buffer the negative health effects of stress by providing emotional and practical resources
• Health behaviors, such as diet, physical activity, and substance use, are influenced by social and environmental factors
  • Unhealthy behaviors are more common in disadvantaged populations and contribute to chronic disease disparities
  • Food insecurity, which is the lack of consistent access to enough food for an active, healthy life, is associated with poor diet quality and increased risk of chronic diseases (obesity, diabetes)
  • Neighborhood built environments (walkability, access to parks and recreation facilities) can influence physical activity levels and chronic disease risk

Social Networks and Health Outcomes

Social Networks and Health

• Social networks, which are the web of social relationships that surround an individual, can influence health behaviors and outcomes through various mechanisms
  • Social support involves the provision of emotional, informational, and practical assistance from social network members
  • Social influence refers to the way in which social network members' attitudes, beliefs, and behaviors can shape an individual's own attitudes and behaviors
  • Access to resources through social networks can include information, material goods, and services that promote health
• Social capital, which refers to the resources and benefits that arise from social networks and relationships, is associated with better health outcomes
  • Bonding social capital involves close ties with similar others (family, friends) and provides emotional support and a sense of belonging
  • Bridging social capital involves weaker ties across diverse groups (coworkers, acquaintances) and provides access to new information and opportunities

Community Resources and Engagement

• Community resources, such as health care facilities, parks, and community organizations, shape access to health-promoting opportunities and services
  • Disadvantaged communities often have fewer health-promoting resources and greater barriers to accessing available resources (transportation, cost, language)
  • Enhancing community resources and addressing barriers to access can improve health outcomes and reduce disparities
• Community engagement and empowerment, which involve the active participation of community members in identifying and addressing health issues, can improve health outcomes and reduce disparities
  • Community-based participatory research (CBPR) is an approach that involves community members as equal partners in the research process, from defining the problem to disseminating the results
  • Community health workers (CHWs) are trusted members of the community who provide health education, navigation, and advocacy services to improve health outcomes and address SDOH
• Social prescribing, which is the practice of referring patients to community resources and activities to improve health and well-being, is an emerging approach to addressing SDOH in healthcare settings
  • Involves linking patients to non-medical services (exercise programs, art classes, volunteer opportunities) to address social isolation, improve mental health, and promote healthy behaviors
  • Requires collaboration between healthcare providers and community organizations to identify and provide appropriate resources