Social Determinants of Health

This week blog is dedicated to the Social Determinants of Health and it effect on health outcomes.

Research has indicated that in the United States medical care (in a hospital or clinic) accounts for only 20% of health outcomes. Conversely, 80% is attributed to socio-economic factors, health behaviors (obesity, tobacco use or alcohol abuse) and the physical environment.

The factors in this latter 80% grouping are what social health and policy experts termed social determinants of health; the new buzz phrase in health quality and quality improvement. Social determinants of health are defined as conditions in the environments where people are born, live, learn, work, play, worship, and age; These conditions in turn affect health and health outcomes. Thus, in addition to inherent risk (nature) and lifestyle choices (nurture), we are now told that social determinants of health play a significant role in morbidly and mortality

Health people 2030 tells us social determinants of health (SDOH) can be grouped into 5 categories:

1. Economic Stability: lack of steady employment and income means this disenfranchised population can’t afford things like healthy foods, health care, and housing.

2. Education Access and Quality: People with higher levels of education are more likely to be healthier and live longer. In addition to generally higher paying jobs, they have better access to healthcare and healthcare services

3. Health Care Access and Quality: Patients may face barriers when trying to access healthcare, such as inadequate transportation, insurance coverage or an absence of providers with the appropriate skills

4. Neighborhood and Built Environment: Patient who reside inneighborhoods with high rates of violence, unsafe air or water etc. it has been noted that Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks.  

5. Social and Community Context: relationships and interactions with family, friends, co-workers, and community members can have a major impact on their health and well-being. Discrimination, social isolation and a lack of community can contribute to stress and other damaging health conditions.


Social determinants of health (SDOH) contribute to wide health disparities and inequities. However just advocating for healthy choices won’t eliminate the health disparities. Rather, public health organizations must collaborate with public and private sectors in education, transportation, and housing to take action to improve the conditions in people’s environments.

A change is coming:

Between 2017 and 2019 The US healthcare industry spent over $2.5 billion on SDOH programs; these are primarily focused on housing interventions, employment, education, food security, social and community context and transportation. The payers, both government and private, in the new pay- for- value model, are recognizing the role played by social determinants in health in outcomes- cost reduction and patient satisfaction prompting them to be even more proactive. 

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