What Are the Social Determinants of Health and Why Are They Important?
Published on Oct 12, 2023. Updated on Dec 7, 2023.
In today’s Osmosis by Elsevier blog, we’re discussing the Social Determinants of Health (SDOH), which helps us recognize and reduce inequalities, promote equity, and enhance overall well-being for us all.
Introduction
The family we're born into, the neighborhoods we grow up in, the places we work, and where we eventually settle down all have a profound influence on our daily lives and, crucially, our overall health and well-being. These vital influences, known as the social determinants of health (SDOH), provide a framework to understand how we access resources and how that level of access shapes our everyday lives.
The SDOH play a pivotal role in shaping our health and the healthcare system's performance since our systems are a reflection of our society. Each of us faces a unique combination of factors that affect our health and well-being; some enjoy a wide array of resources, while others face severe limitations or none at all. As a result of these fluctuations in resource access, there are observable inequities for both individuals and communities.
Let's dive into SDOH and discuss what they entail, how they shape our lives, and why they matter.
What are the Social Determinants of Health?
The SDOH, as defined by the World Health Organization (WHO), are "the non-medical factors that influence health outcomes." These encompass a wide range of factors, including:
Economic Stability
Income and social protection
Unemployment and job insecurity
Working life conditions
Food insecurity
Education Access and Quality
Early childhood development
Health Care Access and Quality
Neighborhood and Built Environment
Housing, basic amenities, and the environment
Social and Community Context
Social inclusion and non-discrimination
Structural conflict
The SDOH are more critical than ever because they create a framework for us to understand and address health disparities while championing policies that promote equity. They underscore the need for healthcare systems to acknowledge the far-reaching impact of social and economic factors on health outcomes. Remarkably, the SDOH have an even greater influence on health than genetic factors (e.g., poverty is strongly associated with adverse health outcomes and an increased risk of premature mortality).
Integrated into healthcare policy discussions in the early 2000s, the SDOH emphasizes the need for a holistic approach to health that goes beyond treating an illness to addressing the root causes of disparities. As we recognize and tackle these factors, we move closer to achieving health equity and better health outcomes for all. This idea is crucial since it can transform healthcare, update and improve policies, and create a healthier, more equitable future for everyone.
Now, let’s take a deeper look at the individual categories that influence health outcomes.
Economic Stability
Being financially stable is essential to everyone’s well-being. It includes factors like a regular income, a social safety net (known as social protection), job security, and working conditions. All of these factors significantly impact a person’s health, affecting everything from their mental health to physical well-being.
Several factors determine how economically stable a person or community is, with income and access to social protection identified as primary indicators. According to the WHO, vulnerable and socially disadvantaged people are getting sicker and dying sooner than those in more privileged social positions. This disparity primarily stems from an increased risk of exposure to harmful substances such as tobacco, inconsistent access to affordable, healthy food (due to lack of transportation and food deserts), and limited access to health services.
Income and Social Protection
A stable income and access to social protection is fundamental for maintaining good health; examples of such protections include policies and programs that provide financial, social, or legal safeguards in times of need or vulnerability. Sadly, due to disparities in access to resources, lower-income individuals often experience poorer health and shorter lifespans.
In the US, one of the wealthiest countries in the world, 1 in 10 people live in poverty, and many can’t afford healthy food, healthcare, and housing. Vulnerable populations – which include racial or ethnic minorities, children, the elderly, those who are socioeconomically disadvantaged, underinsured individuals, or those with certain medical conditions – face even more significant health risks due to limited access to healthcare services, exposure to harmful products, or unhealthy lifestyles.
Unemployment and Job Insecurity
Other critical factors in economic stability are access to employment and job security because they affect our ability to access and pay for health care, in addition to preventative measures like accessing a gym or eating a healthy diet. Being out of work or worrying about keeping your job can lead to serious health issues such as high blood pressure, increased risk of stroke, and a higher risk of heart disease, demonstrating how closely financial stability and health are connected.
In fact, according to researchers, there’s a clear relationship between unemployment and concurrent health problems, including mental health issues like anxiety and depression, along with physical health outcomes, such as high blood pressure, elevated cortisol levels, and early mortality.
Working Life Conditions
Where we work is as important as what we do with regard to our health. Workplace hazards, long work hours, and job salary and satisfaction all play a key role in staying healthy. Exposure to harmful chemicals, use of large equipment, and spending time in high-stress environments significantly increase physical risk, while economic hardship, low pay, and unhappiness at work can lead to physical and mental health challenges and poor health. Addressing these factors through public health campaigns and updated labor policies is vital for improving the social determinants of health and fostering a healthier society.
Food Insecurity
We’re all taught as children that nutritious food is crucial for good health, yet so many people are unable to get regular access to that vital resource. Food insecurity refers to having limited or uncertain access to nutritious food, and it’s strongly associated with high levels of chronic illness and poorer overall health. Challenges with maintaining a steady income or regular job restrict access to fresh food, leading to significantly higher incidences of diabetes, high blood pressure, and heart disease. Increasing access to high-quality, nutritious food is vital to improving health and well-being for everyone.
Education Access and Quality
Studies indicate that children who get a quality education and support during their early years experience better physical well-being, cognitive development, and emotional health. Research also demonstrates that early childhood development and education programs like Head Start play an important role in mitigating risky behaviors and preventing or postponing the onset of chronic conditions.
Early Childhood Development
The first five years of our lives create and impact long-term social, cognitive, emotional, and physical development. Various environmental and social factors – early life stress, socioeconomic status, the quality of relationships we have with parents and caregivers, and access to early educational programs – can either prevent or support development. For example, children who enroll in low-quality schools with limited health resources, safety concerns, and low levels of teacher support are more prone to facing challenges related to their physical and mental health.
When some children don’t get the same opportunities for learning and development in their early years, it can lead to inequitable access to care and, ultimately, how healthy they are. Studies reveal that adults with higher levels of education tend to live longer and healthier lives, and it all begins with our experiences in those first five years.
Health Care Access and Quality
Addressing disparities related to health care access and quality is essential for achieving better health outcomes and improving the overall performance of the healthcare system. Despite major advances in medicine and public health during the past few decades, these disparities persist, particularly among racial and ethnic minority groups who are disproportionately at risk of being uninsured, lacking consistent access to care, and experiencing worse health outcomes from preventable and treatable conditions.
Neighborhood and Built Environment
Where we live and the environment we live in can significantly impact our health, making safe, stable housing a fundamental determinant of health. Homelessness and inadequate housing can lead to mental health disorders, substance abuse, infectious diseases, and chronic health conditions.
Housing, Basic Amenities, and the Environment
Access to safe and stable housing, clean water and sanitation, and a healthy, non-toxic environment are vital factors in the SDOH. Documented discrimination practices like redlining and the development of systems that support bias have created disparities in access to these essentials, adversely affecting community health, and leading to a higher prevalence of non-communicable diseases like stroke, heart disease, cancer, diabetes, and chronic lung disease in these communities. For example, the City of Baltimore analyzed the rate of asthma-related hospitalizations and found that it had three times the number in comparison to the national average, demonstrating a strong correlation between asthma emergencies and local air pollution.
It's essential to advocate for policies to address inequities in order to combat housing discrimination, increase affordability, provide a clean, modern water and sanitation infrastructure, and work toward environmental justice to ensure that everyone has access to the fundamental resources for better health.
Social and Community Context
Social and community context refers to the social environment that we live in, including the social networks, relationships, and cultural norms that influence us. Intentionally excluding people leads to high levels of stress, which negatively impacts both physical and mental health. A supportive social environment promotes positive health outcomes by providing access to resources, offering emotional support, and instilling a sense of belonging. Ensuring inclusivity and combating discrimination are vital to achieving fair, equitable healthcare access and better health outcomes.
Social Inclusion and Non-Discrimination
Social inclusion is the process of ensuring that all of us have opportunities to take part in social, economic, and political activities while being treated with dignity and respect, regardless of background or personal characteristics. With social inclusion, no one is subjected to discrimination for their race, ethnicity, gender, religion, level of ability, or sexual orientation, which helps foster a more equitable and fair society.
Structural Conflict
Structural conflicts are deep-rooted societal issues ingrained within the structure or framework of society and include (but aren’t limited to) racism, sexism, classism, ableism, xenophobia, and homophobia. These conflicts restrict access to education, employment, and healthcare services, worsening health disparities. To create a fair and equitable healthcare system and promote better health for everyone, it’s crucial we acknowledge and embrace inclusivity while actively combating discrimination.
Not surprisingly, discrimination makes it difficult for marginalized people or groups to be fully part of society or exercise the same rights as others. According to the NLM Communities in Action: Pathways to Health Equity report, discrimination based on social identity or location plays a key role in limiting marginalized people’s access to opportunities and services that promote good health.
In other words, the personal, interpersonal, institutional, and systemic inequities that are a result of structural conflicts like racism or sexism create unfair differences in how we’re treated and impact how we access health opportunities and our health outcomes throughout our entire lives.
For example, Black women are more likely to give birth to underweight babies, and those babies are more likely to die, even after accounting for socioeconomic factors. While race itself is a social construct and not a biological category based on innate differences, we can see that racism has biological consequences. Addressing discrimination and developing inclusion-focused policies is essential to ensuring equal, equitable access to quality care and improving health outcomes for all.
Conclusion
The social determinants of health have a profound impact on our lives, well-being, and the performance of our healthcare system and involve a variety of factors that reveal inequalities in our society. Recognizing those inequalities is essential for addressing health disparities while also emphasizing that health goes well beyond our genetics.
Integrating the SDOH into health policy discussions has led to a more holistic approach to health and wellness because it considers social factors necessary to create a healthier, more equitable future. By acknowledging and addressing these factors collectively between healthcare providers, policymakers, and communities, we take a step closer to achieving health equity and better health outcomes for all.
Glossary of Terms
Bias: Thoughts that can shape our perceptions and decisions, often leading to unfair advantages or disadvantages for individuals or groups.
Environmental justice: The fair treatment and meaningful inclusion of all people in the development, implementation, and enforcement of environmental laws, regulations, and policies.
Equity: Recognizing and rectifying past and ongoing inequalities to ensure a fair and even distribution of resources, opportunities, and benefits, ensuring everyone has the support they need to achieve their full potential, regardless of their background or identity.
Equality: Treating all individuals fairly and impartially, providing them with the same opportunities and resources without taking any other factors into consideration. The end goal is to eliminate discrimination and biases by providing everyone with an equal starting point. However, equality best practices often neglect to address existing disparities or account for varying needs, whereas equity focuses on rectifying these imbalances to achieve genuine fairness for all.
Food desert: An area with very limited access to affordable, healthy food leading to poor dietary choices and health disparities due to a lack of grocery stores or local markets.
Food insecurity: Having limited or uncertain access to nutritious food.
Inclusion: Creating an environment where all individuals, regardless of their identity, feel valued, respected, and empowered to contribute fully. Inclusion goes beyond diversity by ensuring equitable opportunities for all.
Marginalization: The systematic exclusion of certain groups or individuals, impacting their overall well-being, leading to reduced access to vital resources, health disparities and social inequalities.
Privilege: Unearned advantages that some individuals or groups have due to their societal position. Recognizing privilege is important for fostering empathy, sharing resources, and leveling the playing field.
Race: The social and cultural construct that categorizes people into different racial groups based on physical characteristics and ancestry.
Racism: A systemic and structural system of discrimination and bias based on an individual's race or ethnicity that maintains and perpetuates social, economic, and political advantages for one racial group while subordinating and disadvantaging others.
Redlining: A discriminatory practice involving the denial of financial services such as mortgage and insurance loans to residents of communities based on their race or ethnicity. Redlining results in less investment in those communities and observable disparities in resources.
Social protection: A social safety net that includes a group of policies, programs, and initiatives designed to provide financial assistance, support, and security to individuals and families in times of need or vulnerability.
Vulnerable populations: Groups at higher risk due to socioeconomic, demographic, or health-related factors, including racial or ethnic minorities, LGBTQIA+, the elderly, children, the socioeconomically disadvantaged, underinsured individuals, or those with certain medical conditions.
Reviewers
Marina Horiates Kerekes, MD, Osmosis by Elsevier Director of Medical AssessmentKelsey Lafayette, DNP, ARNP, FNP-C, Osmosis by Elsevier Nursing Content Manager
Elizabeth Lucas, EdD, RN, CNE, Osmosis by Elsevier Senior Nursing Content Manager
Lisa Miklush, PhD, RNC, CNS, Sr. Osmosis by Elsevier Content Editor, Nursing
Maria Pfrommer, DNP, Ph.D., FNP-BC, RN, Osmosis by Elsevier Director of Nursing Education
Stephanie Stevens, Osmosis by Elsevier Brand Marketing Lead
References & Resources
https://www.osmosis.org/blog/2021/11/08/words-matter-the-power-of-inclusive-language-in-medicine
https://www.environmentalintegrity.org/wp-content/uploads/2017/12/Baltimore-Asthma.pdf
https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-018-0773-5
https://health.gov/healthypeople/priority-areas/social-determinants-health
https://www.scientificamerican.com/article/race-is-a-social-construct-scientists-argue/
Huang, K. Y., Cheng, S., & Theise, R. (2013). School contexts as social determinants of child health: Current practices and implications for future public health practice. Public Health Reports, 128(6_suppl3)
Muennig, P., & Woolf, S. H. (2007). Health and economic benefits of reducing the number of students per classroom in U.S. primary schools. American Journal of Public Health, 97(11), 2020–2027.
Pianta, R. C., La Paro, K. M., Payne, C., Cox, M. J., & Bradley, R. (2002). The relation of kindergarten classroom environment to teacher, family, and school characteristics and child outcomes. Elementary School Journal, 102(3), 225–238.
