Health is influenced by more than just what occurs in a doctor's office. Social determinants of health are environmental and structural factors that drive health outcomes, often inequitably.
Time and time again, initiatives are showing the success of whole person healthcare. One physician, Dr. Julian Tudor Hart, increased his time spent with patients and his efforts to provide comprehensive care outside the doctor’s office for a community in Wales. The results? Lowered rates of smoking, mortality, and lowered hypertension.
Overall, primary care has potential growth points in improving patient outcomes. A patient may visit the doctor, feeling unwell, and be diagnosed with a chronic health condition such as diabetes. In addition to medication, a doctor may advise the patient to avoid eating foods low in sugar, fat, and sodium, replacing these with fresh foods high in fiber and protein. Research shows that dietary changes can greatly improve the health of those suffering from certain non-communicable diseases. Unfortunately, not everyone has the same resources to make these dietary changes. While some may live close to grocery stores with fresh produce or have cars to get there, others live in areas with limited transportation and fresh options. Cost is also a major barrier to purchasing healthy foods. Others may not live in a housing environment where they can store or prepare fresh meals, and even more may not have the knowledge to know how to put together these recipes.
The result? People who know what they need to improve their health, yet conditions outside the doctor’s office make it unrealistic. These are social determinants of health (SDOH), or the environmental conditions of people’s lives that affect their health, both upstream and downstream.
Image Source: https://www.cdc.gov/public-health-gateway/php/about/social-determinants-of-health.html
There are 5 domains of SDOH, including:
Economic Stability
Finances are major drivers of health. Poverty and employment status, including income stability and amount, are elements of economic stability. Steady finances increase people’s ability to engage in health promoting behaviors.
Education Access & Quality
Education, including primary, secondary, and collegiate, is a tool that can unlock job opportunities, which therefore increases economic stability and healthcare access. Furthermore, specific education in health literacy directly impacts people's knowledge of and ability to engage in healthy habits.
Health Care Access & Quality
While health is driven by many factors outside of the doctor’s office, the reality is, many people do not even have access to necessary health services. High rates of un- or under-insured people are hindered from visiting healthcare providers, which means they are not accessing preventative care, health screenings, or essential treatment to manage chronic illnesses.
Neighborhood & Built Environment
The built environment in which people live has the potential to worsen health, whether that be through air and water pollution, or high rates of violence. This also includes factors like being unhoused or spending over 30% of income on housing which reduces economic stability. Built environments also influence the availability of transportation as well as the distance to both healthcare facilities, green space for exercise, and grocery stores for food.
Social and Community Context
Having a supportive community can positively impact physical and mental health, but unfortunately, the opposite may also be detrimental. Discrimination and racism within communities is incredibly harmful to health, and children who face abuse or bullying often suffer health consequences in adulthood.
Social determinants are interrelated, and usually work in tandem to increase health disparities amongst already vulnerable people. Additionally, SDOH are demonstrated risk factors for worse outcomes, but also serve as major barriers to treating and improving these outcomes, resulting in a vicious cycle. One study investigated the variation in nation-wide county health outcomes and found that while receiving clinical care contributed to 20% of the difference between counties, SDOH variables accounted for 50% of this variation.
Social determinants demonstrably affect health in ways that need to be addressed by cross-sector solutions uniting healthcare with community-based organizations to improve community well-being and health equity. Studies show the effectiveness of moving care upstream, and how putting SDOH in the forefront has the potential to improve overall health outcomes.
To cite: Hygieia Consulting. (2024) What Are Social Determinants of Health?. hygieia.llc
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