What are some examples of social determinants of health

The social determinants of health (SDoH) are factors that influence an individual’s health such as the conditions in the places and environments in which people are born, live, learn, work, play and age that ultimately affect people’s health and quality-of-life outcomes and risks.

What are the SDoH?

The SDoH include a diverse array of factors, for example, safe housing, employment status and job opportunities, access to physical activity opportunities, air and water pollution, literacy skills, and discrimination and violence. Various models exist that help to explain and group the SDoH. One of the most common models used to explore the SDoH is Dahlgren and Whitehead’s 1991 model which maps out SDoH at various levels, showing the relationship between one’s health and individual characteristics (both relating to lifestyle and biology); social and community factors; living and working conditions; and wider socio-economic, cultural and environmental conditions. The US Department of Health and Human Sciences groups the SDoH into 5 domains: economic stability, education access and quality, health care access and quality, neighbourhood and built environment, and social and community context.

What is the evidence for using the SDoH?

It is difficult and often misleading to estimate how much of an influence the social determinants of health have, both in relation to each other and in relation to other determinants such as medical care or genetics. Nonetheless, various estimates exist which in general agree that the majority of health determinants are related to the SDoH, as opposed to medical care and biology.

The SDoH provide us with a framework for understanding the broad factors that affect our health, outside of the clinical setting and beyond our biology and genetics, that might be the root cause of health disparities and inequities. For example, if people do not have access to healthy foods (perhaps due to shops not stocking healthy foods, or healthy foods being more expensive than unhealthy foods), they are less likely to have good nutrition, which increases their risk of certain health conditions, such as diabetes and heart disease. Trying to encourage healthy choices is unlikely to eliminate these disparities, but addressing the barriers to healthy food access (the SDoH) could have more success.

How to address the SDoH?

Since the SDoH covers a wide range of health determinants, addressing the SDoH also requires a wide range of activities and policies. A Health in All Policies (HIAP) approach is vital in addressing the SDoH since the health system is often not best placed to address some determinants. For example, health actors can work with the education sector to impact education-related determinants, with the environment sector to address air pollution, or the housing sector to improve the safety of living conditions

Social determinants of health are an individual’s personal circumstances that impact their health and well-being. They include political, socioeconomic, and cultural factors, alongside how easily someone can access healthcare, education, a safe place to live, and nutritious food.

The World Health Organization (WHO) defines social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Social determinants of health are an extensive range of factors that exist throughout all aspects of society. However, they are separate from medical care or a person’s individual lifestyle choices.

A study cited by the National Academy of Medicine found that medical care itself only accounted for 10–20% of the contributors to people’s health outcomes.

By contrast, the many social determinants of health play a much bigger role in influencing a person’s health, making up 80–90% of the contributing factors.

This article explores social determinants of health, including their forms and the roles they play in shaping healthcare outcomes.

Social determinants of health fall into five broad groups:

• Healthcare: This group encompasses a person’s access to healthcare and its quality. Factors include:
  • access to primary healthcare
  • health insurance coverage
  • health literacy
• Economic stability: This refers to the link between a person’s finances and their health. Examples of factors are:
  • poverty
  • employment
  • food security
  • housing stability
• Education: This category focuses on the connection between a person’s access to education and its quality, and their health. Examples include:
  • secondary education
  • higher education
  • language and literacy
  • childhood development
• Social and community life: This group revolves around the ways a person lives, works, plays, and learns and how these relate to the person’s health. Factors include:
  • civic participation
  • discrimination
  • incarceration
  • conditions within a workplace
• Neighborhood: This group considers a person’s housing and environment and the role they play in the person’s health. Factors include:
  • quality of housing
  • transportation
  • access to healthy foods
  • water quality
  • crime and violence

The factors in each group are interwoven and often related to each other.

Around 1 in 10 people in the United States are living without health insurance. This means they may not have a primary healthcare professional. They may also not have the money to make vital purchases for their health, such as medications or tests.

Additionally, people may live too far away from a healthcare clinic to get the quality of care they deserve.

Black Americans are more likely to be uninsured than white Americans. In 2018, 9.7% of Black Americans did not have health insurance. Among white Americans, this rate was 5.4%.

Improving quality healthcare access

There are many ways to help improve public access to quality healthcare. For example, clinics could offer remote appointments where possible.

The Healthy People 2030 campaign has several objectives in place to improve healthcare access. For example, it aims to:

• reduce the wait time in emergency departments
• increase the proportion of adults who receive lung cancer screenings
• increase community services that can provide health screenings

Learn more about health equity here.

Economic stability is vital to affording lifestyle choices and paying for quality medical care that keeps people healthy.

A well-paying, steady job is critical for food security and housing stability. Savings are essential for managing chronic conditions or emergencies.

However, 1 in 10 people in the U.S. live in poverty.

Those in steady work may not earn enough to gain access to good quality healthcare. Moreover, chronic conditions or disabilities may put people at an even greater disadvantage.

Many studies have shown wide gaps in health outcomes between countries and communities that have different social determinants of health. People living in high income countries have a life expectancy that is 19 years higher than that of people living in low income countries.

Improving economic stability

The Healthy People 2030 campaign is organizing programs to increase funding for many institutions, including:

• employment programs
• career counseling
• high quality child care

Establishing certain policies can help people pay for their:

• food
• housing
• healthcare
• education

Learn more about health insurance here.

Data from the U.S. and Europe show a strong association between health indicators and an individual’s income and education level.

Whether a child or adolescent can access quality education throughout their development can determine their future living conditions.

Early childhood education is essential for social and mental development, and good quality high school education can open new doors to further education and employment opportunities.

Children that come from low income households, have disabilities, or experience social discrimination at an early age may be less likely to do well in school. They also face barriers to higher levels of education.

As a result, people from low income households often struggle to get safe, well-paying jobs. It also means they are more likely to experience health conditions such as heart disease, diabetes, or depression.

The stress of having economic difficulties can also adversely impact a person’s health and well-being. For example, living in poverty can negatively affect a child’s brain development.

Improving access to education

The funding of Title I schools in the U.S. has encouraged continued education among those living in low income communities.

The Health People 2030 campaign has several programs in place to improve the proportion of people who have access to high quality education across all age groups.

Interactions between individuals and their family members and co-workers can affect their health.

For example, workplace conditions and discrimination can have an impact on peoples’ moods and self-esteem.

Moreover, high incarceration rates, absent parents, and bullying can all affect a child’s development and feelings of loneliness. This negative effect on a child’s health can continue into their adulthood.

Learn about the effects of racism on mental health here.

Improving community environment

Many social determinants of health are factors that people cannot control individually. Fostering positive relationships at home, at work, or in a person’s community can improve public well-being.

Programs that can better people’s social determinants of health include the social campaigns on the implementation of smoke-free zones that curbed tobacco use and decreased smoking-related disease.

The Healthy People 2030 campaign aims to help people get the social support and care they might need.

For example, it is working to reduce anxiety and depression by providing more support to children and those caring for people with disabilities, among other groups.

A person’s neighborhood and living conditions can directly impact their health and safety.

Many individuals worldwide live in areas with:

• elevated rates of violent crime
• high levels of environmental pollutants
• unsafe air and drinking water

Marginalized racial and ethnic groups, as well as people from low income households, are more likely to live in places that carry these risks.

Even at work, people can come into contact with things that could harm their health, such as secondhand smoke.

Improving living conditions

At local, state, and national levels, people can make changes to improve public environments and overall health.

For example, company owners can reduce health and safety risks at work, and local councils can establish pedestrian or cycle paths.

Learn about how air pollutants affect health here.

The effects of the social determinants of health are more pronounced during crises, as seen in the ongoing COVID-19 pandemic.

A 2021 study found that racial background and socioeconomic status affected COVID-19 incidence and mortality. Marginalized groups are more likely to experience discrimination, crowded living conditions, reliance on public transport, and financial insecurity.

These issues can lead to significant differences in health outcomes during a pandemic.

The conditions into which people are born and in which they live their lives have a profound effect on their health.

Where a person is born, lives, goes to school, and works is what experts refer to as social determinants of health. These factors influence the opportunities a person has to eat a nutritious diet, have a good education, live and work in a toxin-free environment, access healthcare, and more.

The WHO and governmental bodies continually work toward improving the social determinants of health for all citizens to allow equal access to essential healthcare.