From the Guidelines
The social determinants of health are the non-medical factors that influence health outcomes, including economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context, which shape approximately 80% of health outcomes, while medical care influences only about 20%. These determinants can be characterized at the individual level, interpersonal level, or community or societal level, and include domains such as race, ethnicity, sex, sexual orientation, gender identity, immigration status, and acculturation; language and literacy; educational attainment, income, and employment; health literacy, broad access, and digital literacy; dietary quality, and food access and security; and health insurance 1.
Key Social Determinants of Health
- Economic stability (income, employment, food security)
- Education access and quality
- Healthcare access and quality
- Neighborhood and built environment (housing, transportation, safety)
- Social and community context (social support, discrimination, civic participation)
Importance of Addressing Social Determinants
Addressing social determinants requires multi-sector collaboration between healthcare, public health, education, housing, transportation, and social services to create policies and programs that promote health equity and improve population health outcomes 1. For example, individuals with stable housing, adequate income, and strong social connections typically experience better health outcomes than those facing housing insecurity, poverty, or social isolation. These determinants create health inequities when they are distributed unequally across populations, leading to systematic differences in health status.
Implementing Social Determinants in Clinical Practice
Implementing these data standards will require that data attributes such as data formats, data types, target values, and mapping to standardized code sets be developed, and strategies to integrate social determinants of health in electronic health records (EHRs) and data repositories will be necessary to ensure that these data standards can be deployed to achieve more equitable health and optimal health outcomes 1. Health care professionals should evaluate systemic, structural, and socioeconomic factors that may impact food choices, access to healthful foods, and nutrition patterns; behavioral patterns, such as neighborhood safety and availability of safe outdoor spaces for physical activity; environmental exposures; access to health care; social contexts; and, ultimately, diabetes risk and outcomes 1.
From the Research
Definition of Social Determinants of Health
- Social determinants of health (SDH) are defined as the conditions in which people are born, grow, live, work, and age, and the fundamental drivers of these conditions 2.
- SDH include non-medical factors such as socioeconomic status, education, neighborhood/physical environment, social network, employment, and access to healthcare 3.
- Social determinants of health are mutable societal systems, their components, and the social resources and hazards for health that societal systems control and distribute, allocate and withhold, and that, in turn, cause health consequences 4.
Examples of Social Determinants of Health
- Socioeconomic factors such as income, wealth, and education are fundamental causes of a wide range of health outcomes 2.
- Health-related features of neighborhoods, such as walkability, recreational areas, and accessibility of healthful foods, can influence health-related behaviors 2.
- Social factors such as poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability can influence one's health, mental health, and access to care 5.
Impact of Social Determinants of Health
- Social determinants of health can shape individuals' health and affect a wide range of health risks and outcomes, including mortality and morbidity 3.
- Chronic kidney disease disproportionally affects populations with relatively poor social determinants of health 3.
- The COVID-19 pandemic has exacerbated existing social determinants of health, particularly among vulnerable populations such as racial minorities and those with low incomes 6.
Screening and Addressing Social Determinants of Health
- Screening for social determinants of health allows healthcare teams to assess and address social factors that influence one's health, mental health, and access to care 5.
- Health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity, and housing instability 5.
- Addressing social determinants of health can help improve individual and population health, reduce health disparities, and advance health equity 3.