Social Determinants of Health

The environment in which people live, work and learn influences their health. These factors, known as social determinants of health (SDOH), are shaped by forces beyond individual control and contribute to a range of outcomes and risks, including poor health, costly medical care, and premature death.

Research demonstrates strong associations between SDOH and health outcomes. These include:

Education

Education matters for health, as it allows people to access a broad array of material and social resources that can contribute to healthy lifestyles and prevent disease. It also provides access to opportunities to engage in healthy behaviors and avoid hazards, such as smoking, drinking too much alcohol, or eating unhealthy foods.

As a result, communities with higher levels of education have better health outcomes and longer life expectancies. For physicians, this underscores the importance of digging deeper than a standard social history Q&A to explore underlying factors that may impact their patients’ health and well-being. These determinants include both upstream structural factors, such as governance and societal values, as well as downstream intermediary determinants, such as employment and working conditions.

Employment

A person’s work environment is an important determinant of health, as it affects their exposure to pollutants like secondhand smoke. These factors can be regulated at the local, state, and national level, such as by creating smoke-free workplaces or providing safe transportation options.

Individuals’ personal characteristics can also impact their health and well-being, such as race and ethnicity or preferred language. These factors are often influenced by larger societal conditions, such as implicit bias and structural racism. This can lead to steep health disparities among traditionally marginalized racial and ethnic groups. This is why healthcare professionals are encouraging communities to address broader societal issues in addition to medical care.

Housing

As the health care system shifts toward value-based payment models that incentivize outcomes, providers are increasingly focusing on these non-medical determinants. These include a safe and secure home, healthy food options, education, transportation, and community support networks.

Research suggests that housing influences a wide range of health outcomes, including mental health. A safe home free of hazards and stressors can be a protective factor against diseases like asthma. In contrast, living in unsafe conditions, such as high pollution levels and limited access to healthy foods, can be harmful.

The neighbourhood context in which housing is located also affects health, with some neighbourhoods providing a health-promoting environment and others fostering health risks. Neighborhoods that are safe and well-served by local governments, business and civic organizations can help to improve health.

Safety

The physical and environmental conditions in which people are born, live, learn, work, play, worship and age affect a wide range of health, functioning and quality-of-life outcomes and risks. They also contribute to broad health disparities and inequities.

The ability to access healthcare, affordable housing, education, a healthy diet and safe neighborhoods are just some of the factors that determine how easy or hard it is to have good health. These are called social determinants of health.

Unlike personal choice, these determinants are outside of the control of individual individuals and are mostly determined by societal systems. These determinants include racial categories that are created through societal processes of racial ideology and practice and can have deleterious health consequences or ameliorative ones when associated with anti-racist systems.

Nutrition

Many factors contribute to health and well-being, apart from medical care. These include the environment, where people live and work, and how they can easily access food, education, jobs, transportation, and safe living environments.

Various research studies indicate that these social circumstances influence how healthy or unhealthy people are. They are called the social determinants of health (SDOH).

The SDOH perspective broadens prevention efforts beyond healthcare, to include other sectors and community organizations that can affect health. To learn more about these determinants, check out our SDOH literature summaries below:.

Environment

Environmental determinants refer to the physical, chemical and biological influences outside of an individual’s control that impact health and well-being. This includes everything from local air pollution to global climate change.

People deserve the opportunity to live in healthy communities with access to nutritious food, safe housing, quality education and work opportunities and healthcare. Countless organizations are working to address these determinants. However, the new directions pursued by the Trump Administration could limit resources and reduce the effectiveness of efforts aimed at these social determinants. Learn more.

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