What Are Social Determinants Of Health?

Did you know that factors like where you were born, where you live, and your race or ethnicity directly impact your medical care?

Health is a constantly dynamic concept, and it’s heavily impacted by drivers beyond biology. Your socioeconomic level and the social structures surrounding you, as well as your environment and its governing politics, are some of the influential factors. Referred to as the social determinants of health (SDOH), these factors are considered to account for 30–55% of health outcomes worldwide.¹

Capable of positively or negatively affecting your overall health, these sometimes invisible determinants are leading causes of inequity (or poor distribution) of opportunities for medical care. The lower your socioeconomic level, the worse your health outcomes may be, and vice versa.

This article explores the social determinants of health — from how they impact your day-to-day life to ways we can work together to improve global health inequities and injustices.

What are the social determinants of health?

The social determinants of health are non-medical factors that can positively or negatively impact health outcomes and quality of life.

According to the US Department of Health and Human Services, the social determinants of health can be grouped into five primary domains:²

Economic stability

Having stable employment, housing, sufficient nutritious food, and living above the poverty line all contribute to economic stability.

In 2023, what is defined as the federal poverty level for a two-parent, two-child household in the US means having a monetary yearly gross income of $30,000 (which does not include the value of benefits like food stamps). For an individual, the poverty threshold is defined as having a yearly gross income below $14,580.³

The overall US poverty rate has declined in many states over the past decade, but it was estimated in 2021 that 11.4% of the population (37.2 million people) still lived in poverty.⁴ ⁵

Living in poverty increases health inequities and may lead to what is sometimes referred to as the health–poverty trap — when poor health further reduces income.⁶ Conversely, those with higher and more stable incomes are significantly more likely to access high-quality medical care and have longer lifespans.⁷

Education access and quality

Being able to access higher levels of education is connected to better overall health outcomes. Your gender, age, where you were born, where you live, and your financial means all play a role in the level of education you might be able to achieve.

Higher education can help you secure higher-paying jobs with fewer occupational hazards. It also increases your chance of having premium health insurance benefits. In addition, if you have a higher income, you may be more able to pay for higher quality or specialized healthcare.

Attaining better education can improve your understanding of health and well-being, also known as your level of health literacy. This knowledge may reduce your likelihood of adopting unhealthy habits or engaging in behaviors that increase the risk of illness, such as smoking.⁸

Access to quality healthcare

Health outcomes are directly impacted by timely, effective care. Healthcare quality and price (whether it’s free, affordable, or covered by health insurance); availability of healthcare specialists; length of wait times; and access to emergency services all affect the level of care you can receive.

Neighborhood and built environment

The characteristics of your neighborhood and built environment can significantly impact your quality of life and health outcomes. For example, the availability of supermarkets and grocery stores in your local area affects your access to healthy, affordable food. Meanwhile, if your neighborhood doesn’t have a sufficient public transport system, you might have difficulty reaching a grocery store or healthcare facility.

The amount of social and health support your community receives also shapes health outcomes. You might have better access to support services if your neighborhood is near a city center. Remote areas, on the other hand, may have reduced access to services.

Factors like crime rates, exposure to chemicals, and air and water safety may also influence your health outcomes. Furthermore, whether or not you can easily and safely exercise in your neighborhood could make the difference between enjoying a healthy life and developing chronic diseases. For example, having bike lanes and parks in your local area makes it much easier for you to do sufficient exercise.

Social community

The availability of social support (whether personal or institutional) directly impacts your overall health. In addition, social, political, and cultural practices play a role in making care accessible. Systemic discrimination, racism, or isolation increase the risk of adverse outcomes.

Social determinants of health according to the World Health Organization

Within the above five categories, the World Health Organization (WHO) identifies examples of other social determinants of health that positively or negatively impact health equity. These include the following:⁹

• Amount of social protection

• Job security and the unemployment rates

• Access to affordable housing

• Food security

• Access to nutritious, healthy foods

• Access to basic amenities, like clean water and electricity

• Support for early childhood development 

• Exposure to trauma or conflict

The social determinants of health cause health inequities

You have likely heard the phrase, “Health is wealth,” and this sentiment rings particularly true in reference to the social determinants of health.

People living in countries or regions with limited resources and incomes are at an increased risk of experiencing health inequities. Over time, these health inequities affect a person’s risk of developing chronic disease — a situation that directly impacts their quality of life, ability to work, and financial or social status within society and their community.

According to the WHO, people living in lower-income countries and regions experience unjust health outcomes.¹

• Globally, although the number of people diagnosed with cancer is higher in high-income countries, the total mortality rate from these cancers is significantly higher in middle- and low-income countries, particularly for those under 65 years of age.¹⁰

• Children under five years of age living in Sub-Saharan Africa have a 14 times higher mortality rate than those living across Europe and North America.¹¹ Children growing up in economically disadvantaged countries are also more likely to face slower improvements in child health and care compared to similar children in countries with a larger gross domestic product (GDP).

• For people in high-income countries, the life expectancy is 18 years longer than those in low-income countries.¹²

Even within richer countries, some areas and groups still experience inequities in access to care and basic human amenities. The WHO reports that relative gaps within countries between richer and poorer subgroups for diseases like cancer have increased in all areas of the world. For example, while the US is known to be one of the wealthiest countries in the world, different states experience varying levels of affluence and access to care (New Hampshire has a poverty rate of 7%, while Mississippi’s is 18.7%).¹³

Additionally, communities of people of color in the US, including Black, Hispanic, Native American, Alaskan, Pacific Islander, and Asian people, have significantly less access to high-quality and timely healthcare when compared to White people. As a result, these populations often experience worse health outcomes and a higher mortality rate for many health conditions than their White counterparts.¹⁴

These unethical health inequities can always be challenged and systematically changed through social, healthcare, and political actions.

The future includes improved health equity

The negative impact of social determinants on health is an avoidable aspect of modern society and politics. Policies can be changed to improve medical care and health outcomes for millions of people worldwide.

Various public health organizations and stakeholders recommend the following measures:¹⁵ ¹⁶

1. Improve daily living conditions with policies and programs that address the social determinants of health. Such measures might include affordable housing, safe neighborhoods, clean air, and access to healthy food. Daily living conditions can be improved through well-researched urban planning, infrastructure development, and community revitalization initiatives.

2. Tackle the inequitable distribution of power, money, and resources. This objective includes advocating for equitable resource distribution in the form of fair wages, affordable health care, and access to quality education regardless of socioeconomic status.

3. Improve economic opportunities and better access to jobs in underserved communities by supporting job training, vocational education, and entrepreneurship. These goals can be achieved through government partnerships with local businesses, providing mentorship opportunities, and creating job placement programs.

4. Implement policies and initiatives to improve health equity for disadvantaged populations. These mandates should address the specific health needs and challenges that marginalized communities face. For instance, increased access to medical services, health education programs, and culturally competent care.

5. Integrate training about social determinants of health into medical school, nursing, and other healthcare professional curriculums. This modernization will help healthcare providers better understand and address social factors that influence health outcomes, leading to more effective and equitable care.

6. Routinely evaluate public policy interventions and their impact and adjust them using evidence-based research. Regularly assessing the effectiveness of programs and policies that address geographical, educational, occupational, social, nutritional, and environmental factors that contribute to health inequities.

The lowdown

The number of poor health outcomes that result from disparities in the social determinants of health shows the severity of inequity in our current global, political, and social climate. These factors are changeable. But, the only way to improve outcomes is to work together to adjust and realign our current systems to allow optimal, ethical, and comprehensive care for everyone.

Appropriate medical care should involve assessing individuals and communities for their protective health factors (strengths) too, such as your social connection with your family or community.

The study of social determinants of health is a valuable research and screening tool. However, it’s important to ensure the results are used to mitigate adversity rather than accidentally reinforce stereotypes.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s). Have feedback? Email content@healthmatch.io.

References:

1. Social Determinants of Health | The World Health Organization

2. Social Determinants of Health | Healthy People 2030 — Office of Disease Prevention and Health Promotion

3. Federal poverty level (FPL) | HealthCare Gov

4. How Have State Official Poverty Rates Changed Over 10 Years? | United States Census Bureau

5. National Poverty in America Awareness Month: January 2023 | United States Census Bureau

6. Health, Income, & Poverty: Where We Are & What Could Help (2018)

7. The Association Between Income and Life Expectancy in the United States, 2001-2014 (2016)

8. Smoking remains associated with education after controlling for social background and genetic factors in a study of 18 twin cohorts (2022)

9. Social Determinants of Health | The World Health Organization

10. Cancer Control in Low- and Middle-Income Countries: Is It Time to Consider Screening? (2019)

11. Child mortality (under 5 years) | The World Health Organization (2022)

12. Uneven access to health services drives life expectancy gaps: WHO | The World Health Organization (2022)

13. Poorest States 2023 | Wisevoter

14. Communities in Action: Pathways to Health Equity. 2: The State of Health Disparities in the United States (2011)

15. Commission on Social Determinants of Health, 2005-2008 | The World Health Organization

16. Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper (2018)

Claire Bonneau is a medical writer and certified trauma operating room nurse.