Social Determinants of Population Health

Summary / Explanation

This activity will define social determinants of health (SDOH), explain their key domains, discuss the broad impact of SDOH on various health conditions, and identify potential strategies to address SDOH within clinical practice and broader healthcare systems.

Definition and Clinical Relevance

The Centers for Disease Control and Prevention (CDC) has adopted the World Health Organization's (WHO) definition of SDOH as the "nonmedical factors that influence health outcomes. They are 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." (CDC. Social Determinants of Health at CDC.) [1] For clinicians, understanding SDOH is crucial for the below-mentioned reasons.

• Root causes of health disparities: SDOH are the primary drivers of persistent health inequities experienced by marginalized populations.[1] Recognizing this expands the clinical lens beyond individual behaviors to societal factors.

• Patient-centered care: Awareness of a patient's SDOH facilitates understanding the challenges they may face in accessing care, adhering to treatment, and managing health conditions.[1][2]

• Diagnostic accuracy: SDOH can influence disease presentation and severity, potentially affecting diagnostic processes.[1]

Key Domains of Social Determinants of Health

• Economic stability: Income inequality, unstable employment, food insecurity, unaffordable housing, and medical debt impact health behaviors, preventive care access, and chronic disease management.[1][2][3][4]

• Education access and quality: Health literacy, understanding of disease prevention, and self-management skills are strongly tied to educational attainment. Limited health literacy can create barriers to navigating the healthcare system and effectively managing health conditions.

• Neighborhood and physical environment: Exposure to environmental toxins, limited access to healthy food and safe exercise spaces, and neighborhood crime rates all shape physical and mental health.[2][3]

• Social and community context: Experiences of systemic discrimination (eg, racism and sexism), inadequate social support, and limited community resources influence stress levels and the availability of health-protective factors.[2][3] Chronic stress from these factors can contribute to adverse health outcomes over time.[5][6]

• Healthcare access and quality: Insurance coverage, availability of culturally competent providers, transportation barriers to care, and bias within the healthcare system significantly affect health service utilization and treatment outcomes.[2][3] Language barriers and cultural differences may hinder effective communication and treatment adherence.[6]

Social Determinants of Health and Health Outcomes

SDOH has a wide-ranging impact on health and disease, as mentioned below.

• Chronic diseases: SDOH contributes to the development and severity of cardiovascular disease, diabetes, hypertension, and certain cancers and contributes to poorer management of these conditions.[1][7]

• Mental health: Adverse SDOH increases risks for depression, anxiety, substance use, and other mental health conditions.[2]

• Maternal and child health: SDOH influences birth outcomes, infant mortality, and children's physical and cognitive development.[3]

• Other health impacts: SDOH influences infectious disease risk, exposure to injury and violence, and overall life expectancy.[2][3][6]

Interventions to Address Social Determinants of Health

Addressing SDOH requires action within and beyond the clinical setting.

• SDOH screening: Validated screening tools (eg, PRAPARE ) should be incorporated into routine intake forms to identify areas of risk.[1]

• Community resource referral: Partnerships with social services, legal aid, and community programs should be developed to address patients' needs holistically.[1]

• Policy advocacy: Policies promoting fair wages, affordable housing, educational opportunities, and health equity should be supported by clinicians.[1] They should also advocate for policies that address the systemic factors contributing to health disparities.[5]

Healthy People 2030

Healthy People 2030 is the latest iteration of the US Healthy People initiative (health.gov. Healthy People 2030), representing the national blueprint for improving the health and well-being of all Americans over the next decade. This initiative outlines a comprehensive set of data-driven objectives and targets to address the nation's most pressing public health challenges.

Key Aspects of Healthy People 2030

• Specific targets: Outlines nearly 500 specific, measurable targets spanning 42 health topic areas to track and improve nationwide health status.

• Health equity: Prioritizes achieving health equity as a core principle by eliminating disparities among different population groups.

• Collaborative approach: Advocates for a multiple-sector, collaborative approach that integrates efforts across public health.

• Emerging issues: Increases attention on emerging issues such as the opioid epidemic, mental health challenges among youth, inadequate physical activity, poor nutrition, and environmental impacts.

• Interactive platform: Features an interactive online platform to enhance public access, transparency, and engagement with the objectives and data.

• Life stage goals: Aim to enable all Americans to reach their full potential for healthy, thriving lives throughout all life stages.

• Evidence-based framework: Establishes an evidence-based framework to guide policies and focused interventions that cultivate a society supportive of healthy behaviors and environments.

Summary

SDOH profoundly influences the health and well-being of individuals and populations. A robust understanding of SDOH is essential for clinicians seeking to deliver equitable care and address the root causes of health disparities. By incorporating SDOH screening, community resource referrals, and policy advocacy into healthcare practice, providers can move beyond solely treating disease and actively contribute to creating a more just and equitable healthcare system for all. Many initiatives exist to address SDOH in various nations, with Healthy People 2030 being a prominent example in the U.S. This national blueprint sets data-driven goals and measurable objectives to promote health, well-being, and health equity for all Americans over the next decade.