Social determinants of health refer to all the cultural, economic, and social factors that can impact upon a person’s health. These can include a person’s neighborhood, prejudices they face, and accessibility of clean food and water.
The health of an individual is profoundly affected by the conditions and environments in which they are born, grow up, live their lives and work. These conditions are known as the social determinant factors.
These social, economic, and environmental conditions encompass everything from access to healthy food to safe walkways and parks in neighborhoods that affect individual well-being.
People’s life expectancy, quality of life, and disparities in health outcomes largely depend on their socio-economic status, race/ethnicity, or geographical location.
For instance, poverty is a significant determinant factor shaping an individual’s health. Poor people face significant barriers in accessing healthcare facilities, such as shortage or unavailability of hospitals in the area.
Definition of Social Determinants of Health
Social determinants of health (SDOH) are the non-medical factors or conditions that influence an individual’s overall health and well-being.
Social policies, societal norms, cultural practices, and economic systems all shape SDOH.
According to the U.S. Department of Health and Human Services (2022),
“Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affects a wide range of health, functioning, and quality-of-life outcomes and risks.”
These factors include access to healthy food options, safe and secure housing, clean water sources (or lack thereof), employment opportunities and working conditions, and educational attainment levels, amongst other aspects. As stated by Islam (2019),
“…opportunities to have an education, a healthy living environment, nutrition, healthcare, and employment are some of those resources” (p. 2).
SDOH are known to significantly impact an individual’s health outcomes more than just genetic makeup or personal habits.
10 Examples of Social Determinants of Health
- Homelessness: People who are homeless are at higher risk for obesity (due to not having access to healthy foods), substance abuse, infectious diseases such as tuberculosis or Hepatitis B and C, as well as other communicable diseases due to exposure to unsafe conditions in shelter facilities. Furthermore, lack of housing security causes chronic stress triggered by unstable living conditions impacting mental health status development over time (Lazar & Davenport, 2018).
- Food Insecurity: People without stable access to healthy and affordable food sources within a reasonable distance of their homes often experience chronic hunger and malnutrition. Notably, healthy food needs to be affordable. For example, many poorer people are often constrained to purchasing cheaper foods that don’t provide sufficient nutrients.
- Income Inequality: Lower-income individuals often lack access to reliable healthcare services and basic amenities due to inability to afford them. It makes them vulnerable and more susceptible to chronic illnesses over time. Furthermore, wealthier individuals are able to access preventative healthcare services at a greater rate then low-SES families.
- Education Attainment Level: Many studies (e.g. for a good introduction, see Möwisch and colleagues, 2020) show that individuals who attain higher levels of education tend to have better physical and mental well-being. These individuals attain better employment opportunities offering better healthcare coverage and higher incomes. Thus, they are able to meet their own preventative health needs and exposed to fewer adverse long-term outcomes.
- Geographic Location: Distance from health facilities can exacerbate health issues, which is why rural populations often face unique healthcare needs (Ford, 2016). Furthermore, people living, working, or recreating in locations near industrial sites that pollute the air with chemicals are more prone to respiratory issues, such as asthma, regardless of demographic background.
- Gender Discrimination: Women face various SDOH-related disadvantages that can impact not only their general health but also their mental well-being. These can include gender-based harassment, violence and/or occupational disparities. Furthermore, policies restricting women’s control over their reproductive health can exacerbate health disparities.
- Racial Discrimination: Minority ethnic groups have historically tended to receive less quality medical services than non-minority groups. This can be due to implicit biases and prejudices, less access to resources, or mistrust of healthcare professionals (Alvidrez et al., 2019). It results in higher mortality rates amongst minorities from preventable illnesses such as cancer.
- Language Barriers: Some ethnic groups cannot fluently express themselves when seeking easily accessible medical services. It makes communication difficult between patient and practitioner, hindering care outcomes, especially post-treatment follow-ups.
- Transportation Barriers: People without reliable transportation access often delay seeking medical aid until a condition worsens. It results in higher costs for emergency care services that could have been avoided with preventive treatment options if accessible earlier.
- Housing Insecurity: Individuals experiencing unstable housing conditions due to poverty, domestic violence, or natural disasters are at higher risk of poor health outcomes since they lack safe shelter, hygiene facilities, or storage for medications/medical equipment as needed.
Origins of Social Determinants of Health
The quest for health equity started in 1967 with the UK Whitehall study, which revealed a clear link between social status and health outcomes (Wigger, 2018).
This study highlighted a gradient of health based on socio-economic status (SES), where higher SES levels predict better overall health outcomes, while lower SES predicts poorer health.
This research marked the beginning of significant changes in public policy toward addressing systemic issues in addition to clinical interventions (Wigger, 2018).
Factors contributing to disparities ranged from inadequate housing conditions within low-income communities, limited access to quality healthcare services determined by individual insurance coverage, or other factors like race or ethnicity.
Moreover, marginalized groups constantly faced disproportionate effects of environmental hazards like air pollution elevating risks factor contributing to chronic illnesses, thus further jeopardizing one’s overall well-being.
These studies led to an awareness of the numerous SDOHs impacting people’s lives and ignited discussions about policymaking bodies focusing policies not just on medical interventions but also eliminating systemic barriers fuelling such disparities.
This awareness generated a need for comprehensive socio-economic interventions promoting healthy living irrespective of individual demographic standing towards a more equitable society.
Five Main Social Determinants of Health
Healthy People 2030 initiative has categorized SDOH into five domains – economic stability, education access, and quality, health care access and quality, neighborhood and built environment, and social and community context.
Let’s have a look at each of these domains:
1. Economic Stability
Economic stability is one of the major social determinants of health (U.S. Department of Health and Human Services, 2022).
Having access to basic resources like food, shelter, and healthcare requires financial resources, which individuals living under economic instability may struggle to obtain.
The impact of economic instability on health includes poor nutrition, mental health issues, and chronic diseases that develop due to stress.
2. Education Access and Quality
Education is another social determinant that significantly influences an individual’s health outcomes (U.S. Department of Health and Human Services, 2022).
Studies have consistently shown a strong link between lack of educational attainment and poorer job outcomes.
By contrast, highly educated individuals tend to fare better in terms of salary, career advancement possibilities, and supplementary benefits like access to healthcare coverage.
Also, sound knowledge leads to better decision-making skills regarding personal life choices, such as healthy eating habits and physical exercise patterns resulting in reduced use of harmful substances like alcohol or tobacco.
3. Health Care Access and Quality
People who lack adequate healthcare services face severe disadvantages (U.S. Department of Health and Human Services, 2022).
Instead, those who have access to quality healthcare services get positive health benefits leading to a long healthy life span, consequently spending more time living healthier lives with their family members than being isolated at home sick.
Income inequality typically results in lower quality healthcare access for people who need it most, negatively impacting their well-being.
4. Neighborhood and Built Environment
Neighborhoods providing safe environments promote daily activities such as walking or biking to reduce obesity rates due to increased physical activity (U.S. Department of Health and Human Services, 2022).
Besides, safe neighborhoods create a positive atmosphere reducing air pollution levels responsible for respiratory illnesses such as asthma and bronchitis and encouraging overall well-being by developing healthy lifestyle habits in locally residing individuals.
5. Social and Community Context
Finally, social support networks plus community circumstances play vital roles in maintaining individual well-being across all ages playing an essential role during times of crisis (U.S. Department of Health and Human Services, 2022).
Supportive relationships within established socio-cultural contexts help maintain human interaction, which fosters mental well-being through behavioral change toward healthier lifestyles.
For example, group sports or volunteerism helps individuals handle similar afflictions while creating a support network.
Finally, collaborative efforts instead of self-reliance approaches help solve problems by establishing a positive feedback loop.
Importance of Social Determinants of Health
Analyzing social determinants of health is crucial to identifying and addressing factors that contribute significantly to health outcomes in individuals and communities.
One key importance of analyzing social determinants of health is that it helps identify populations with a higher risk of poor health outcomes due to poor access to quality education resources, nutritious food, safe neighborhoods, etc.
By understanding the nature of these factors associated with different population demographics, policymakers can design programs tailored specifically to address underlying causes (Chelak & Chakole, 2023).
Another critical importance is that analyzing social determinants allows for the identification of the most significant causes leading to rising individual and societal costs linked with long-term chronic diseases (U.S. Department of Health and Human Services, 2022).
For instance, promoting healthy lifestyle habits among people within socio-cultural contexts can result in improved health outcomes and reduced spending on medical treatment.
Moreover, social determinants analysis emphasizes primary prevention strategies by addressing underlined causes instead of dealing exclusively with symptoms after they have developed beyond control (Jansen et al., 2012).
Setting up interventions targeting these underlining problems promotes positive change and eliminates burdensome policies.
Lastly, not only does analysis provide insights into specific situations for groups but also highlights general patterns leading over time, indicating areas that need immediate transformational approaches fostering further stability.
Individuals’ overall well-being is closely tied to their socio-economic status and environmental factors – collectively known as social determinants of health.
Healthcare professionals and policymakers must consider social inequalities as underlying causes when predicting or improving individual or population health outcomes.
From access to education to safe neighborhoods, social determinants of health play an essential role in helping individuals live healthier lives.
Analyzing the importance of social determinants is crucial in achieving a higher quality of life for individuals within communities through improved health outcomes.
This approach also helps healthcare systems reduce costs by promoting healthy living practices among the population.
Alvidrez, J., Castille, D., Laude-Sharp, M., Rosario, A., & Tabor, D. (2019). The national institute on minority health and health disparities research framework. American journal of public health, 109(S1), S16-S20.
Chelak, K., & Chakole, S. (2023). The role of social determinants of health in promoting health equality: A narrative review. Cureus. https://doi.org/10.7759/cureus.33425
Ford, D. M. (2016, November). Four persistent rural healthcare challenges. In Healthcare management forum (Vol. 29, No. 6, pp. 243-246). Sage CA: Los Angeles, CA: SAGE Publications.
Islam, M. M. (2019). Social determinants of health and related inequalities: Confusion and implications. Frontiers in Public Health, 7(11), 1–4. https://doi.org/10.3389/fpubh.2019.00011
Jansen, C., Sauter, S., & Kowalski, C. (2012). The influence of social determinants on the use of prevention and health promotion services: Results of a systematic literature review. GMS Psycho-Social-Medicine, 9, Doc07. https://doi.org/10.3205/psm000085
Lazar, M., & Davenport, L. (2018). Barriers to health care access for low income families: A review of literature. Journal of Community Health Nursing, 35(1), 28–37. https://doi.org/10.1080/07370016.2018.1404832
Mowisch, D., Brose, A., & Schmiedek, F. (2020). Do higher educated people feel better in everyday life? Insights from a day reconstruction method study. Social Indicators Research, 153(1), 227–250. https://doi.org/10.1007/s11205-020-02472-y
U.S. Department of Health and Human Services. (2022). Social determinants of health. Healthy People 2030; U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/social-determinants-health
Wigger, E. (2018). The Whitehall study. Unhealthywork. https://unhealthywork.org/classic-studies/the-whitehall-study/