“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems if I am to care adequately for the sick.” Dr. Louis Lasagna, 1964
We all want to feel our best every day, but with the current healthcare model in the United States (along with countries such as Nigeria, Yemen, South Africa, Egypt, Afghanistan, Pakistan, and Iran), supporting community health and well-being is a costly endeavor, with far too many people having to make the difficult choice between healthcare, food, or housing. This problematic situation is strongly influenced by factors like our level of education, socioeconomic status, the language(s) we speak, and the quality of the environment we’re living and working in, making it clear that many people face systemic barriers, impeding access to essential care and services, and compromising overall quality of life.
This is where the Social Determinants of Health (SDOH) come into the picture. SDOH are the various factors we experience daily that impact individual well-being and overall community health. Let’s do a quick review to refamiliarize ourselves with them.
Understanding Social Determinants of Health (SDOH)
The Centers for Disease Control (CDC) defines SDOH as the external (environmental, social) factors influencing health that include (but aren’t limited to) economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
These factors are affected, directly and indirectly, by the systemic structures that shape our daily lives, including external systemic factors such as governmental structure, regional economics, justice system structure, social policy, racism, and climate change. While many of these social factors are perceived as changeable and within our control, they’re often difficult to address and overcome because of the impacts of well-established systemic forces. Let’s explore some of those factors.
Economic stability/socioeconomic status plays an important role in our ability to access healthcare. For example, health insurance is vital to a patient’s ability to receive healthcare in the US, however, access isn’t guaranteed. Instead, employment status or location typically determines whether patients can receive health insurance and what level of coverage they get. The combination, or intersection, of economic stability with healthcare at an individual and regional level plays a key role in how we access care and support good health. In addition, our socioeconomic status also affects our ability to purchase nutritious food, live in well-maintained and safe housing, and receive a quality education, which further shapes health outcomes.
Education access and quality indirectly impact our ability to access healthcare and the potential health outcomes. Higher levels of education are often associated with higher income levels and stable employment, making it easier to get health insurance coverage and receive higher-quality healthcare services. However, the ability to access a higher-quality education is also influenced by systemic infrastructures such as policy, laws, and the distribution of economic resources. Disparities in funding distribution, construction and maintenance of facilities, and availability of adequate resources in communities often complicate or interfere with factors in addressing education access and quality.
Neighborhoods and the environment are planned and paid for through systemic infrastructures (e.g., elected officials, urban planners, along with public and private development organizations), which means that the people who live in those communities have minimal to no control over how to address complex social issues like crime, education, and healthcare in their neighborhoods.
Local governments decide the status and stability of the health of their community by determining the quantity, quality, and level of access people have to food, education, safety, and healthcare facilities (e.g., hospitals, clinics, and primary care providers) in their area.
In addition, factors such as exposure to environmental hazards and pollution can increase the risk of developing chronic diseases and other health conditions. While promoting healthy behaviors and lifestyles is necessary, so is developing strategies to address social determinants of health, promote and ensure fair access to healthcare resources, and create supportive environments that facilitate healthy behaviors and lifestyles for all residents.
Healthcare access and quality impact an individual’s health outcomes and well-being by influencing healthcare services’ effectiveness, safety, and patient-centeredness. Marginalized and vulnerable populations often face barriers to receiving high-quality healthcare due to socioeconomic disparities, limited availability/access to providers, systemic biases and discrimination, inadequate resources and infrastructure in their community, and lower health literacy levels.
Other systemic barriers, such as geographic remoteness (living in a rural or underserved area), transportation limitations, and language barriers, also hinder a person’s ability to access prompt and proper care. Provider-patient communication, continuity of care, and adherence to clinical guidelines all change the quality of care delivered. When patients have fair access to healthcare services and improved quality of care, healthcare systems achieve better health outcomes for all individuals, regardless of socioeconomic status, race, ethnicity, or other demographic factors.
Social support and community networks are crucial in shaping our access to healthcare and health outcomes through strong social support networks (family, friends, and community organizations) that provide emotional, functional, and informational help to individuals during illness or need. Community-based organizations and support groups can serve as valuable resources for individuals facing specific health challenges, offering peer support, education, and advocacy.
When the importance of social support and community networks is recognized in relationship to healthcare access and outcomes, it helps underscore the need to strengthen these resources and promote social cohesion within communities to improve health equity and overall population health.
The Interplay Between Social Determinants and Access to Healthcare
The connection between SDOH and healthcare access is significant, shaping health outcomes for individuals and communities alike. Marginalized communities often face barriers that impede their access to prompt and quality care. These inequities worsen existing health disparities, leading to unequal distribution of resources and worsening health inequities.

Addressing Healthcare Disparities Using Social Determinants of Health
Addressing healthcare disparities requires that you, as a provider, take a consciously integrated approach by considering factors outside of a patient’s control. In recognizing and addressing the underlying SDOH while working within established systems you can help to lessen disparities and achieve improved health outcomes for entire communities, no matter their circumstances or status.
Now that you’re clear on the foundations of SDOH, let’s put what we’ve learned into action using real-world examples that demonstrate the impact of social determinants on healthcare access. As a future provider, consider what you can do to avoid or prevent SDOH from impacting health access or outcomes in the following scenarios.
1. When you prescribe medication to a patient with diabetes on a food aid program.
Barrier: Economic Stability/Socioeconomic Status
To address this SDOH, confirm that the medication is covered by insurance, consider using a generic, and educate your patient on the use of discount prescription cards, pharmaceutical prescription aid programs, and grant programs.
2. When you ask your patient with prediabetes to walk thirty minutes daily to help decrease cholesterol and increase insulin sensitivity.
Barrier: Neighborhood/Environment
You must engage the patient to find out if an increase in outdoor activity is possible in their community. If not, you need alternative options for the patient to try.
3. When you ask a patient with a negative pap smear if they want the HPV vaccination.
Barrier: Healthcare Access/Quality
Increasing your patient’s health literacy is an aspect of quality of care. Don’t just hand them a pamphlet. Ensure they understand their health status and needs and can participate in treatment and care plans (which also goes together with informed consent). The more patients can understand the pros/cons of their decision, the better their compliance, leading to improved outcomes.
4. Discovering that the patient, who speaks a different language, has brought a family member to translate for them.
Barrier: Social Support/Communication
Always do your best to ensure there’s a translator available in the patient’s native language. In a small clinical setting, telephone programs and apps such as Systran, Paraphrase, or even Google Translate can be downloaded in emergencies. It’s vital that we don’t allow friends or family to translate because of the potential for miscommunication or the accidental omission of information that can affect a patient’s choices for their care.
The Link Between Social Determinants and Access to Healthcare
Marginalized communities often face barriers that impede their access to prompt and quality care. These inequities worsen existing health disparities, leading to unequal distribution of resources and worsening health inequities.
The relationship between access to care and social determinants highlights the many factors that shape a patient’s ability to receive prompt medical services and emphasizes the need to develop comprehensive strategies that promote fair access to healthcare to improve health outcomes for all individuals, regardless of their circumstances. In taking the time to understand how social determinants influence access to adequate care, policymakers and healthcare providers are then able to develop targeted interventions to address underlying social inequalities and improve healthcare access for all individuals.
Conclusion
Understanding the role of social determinants of health (SDOH) in accessing healthcare is challenging and complex. There isn’t a quick or simple answer, and it can’t be fixed overnight. Progress is made by initiating and facilitating proactive change across a range of systems and practices.
As a health professional, it’s vital to understand that a patient’s behaviors are not simply a consequence of their choices but of their environment as well. It’s critical that you meet the patient where they’re at without judgment. Becoming a clinician means you’re not just a scientist but also a sociologist, educator, advocate, and, at times, social worker. In finding that balance within the patient and provider relationship, you’ll foster trust, provide more personalized care, and ultimately improve health outcomes by addressing the broader context of each patient’s life.

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