Social determinants of health are officially defined as conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Put in simpler terms, they are all the non-medical aspects of an individual’s life that—sometimes unexpectedly—impact the quality of their health.  

SDOH are critical to understand, especially in the context of health disparities and inequity. If one lives in a low-income environment where access to higher education is difficult, turning to jobs that require physical labor or poor working conditions can ultimately lead to more health problems down the line. These factors can have enormous negative effects and can be particularly devastating when compounded together . 

There are five key categories that these determinants are typically grouped into: Education Access and Quality, Healthcare Access and Quality, Neighborhood and Built Environment, Social and Community Context, and Economic Stability. 

Education Access and Quality

As previously mentioned, access to education can be a crucial aspect of one’s health. Given that health is heavily correlated to one’s status or social position, performance in school and access to education can play key roles in one’s well-being. The AMA Journal of Ethics observes that positive early learning experiences help improve cognitive functions and the ability to handle stress, which can later aid in handling challenging experiences and acquiring new skills. 

If individuals are unable to obtain a good education, their health can be significantly compromised in the future. The lack of a quality education can set a person back in life and render it more difficult for them to climb the socioeconomic ladder or secure a good job. This in turn causes individuals to have a harder time affording healthcare services, which can ultimately negatively affect physical, emotional, and mental health. 

Healthcare Access and Quality

Health insurance and coverage continues to be a hot-button topic in the United States, and for good reason. The U.S. Department of Health and Health Services states that people who do not have health insurance typically do not have primary care providers, indicating that they won’t get healthcare services recommended to them or even know about what resources they have access to. 

Furthermore, one’s location can also have a huge effect on their ability to access healthcare. If someone is located far away from clinics, hospitals, and other healthcare resources, getting the same access to resources that other people may have becomes difficult. For example, a study discovered that while most U.S. adults had geographic access to a primary care physician, statistics can begin changing when turning to certain specialists or doctors. In urban clusters, a pulmonologist was available for only 38.3% of the population, and only 34.5% in rural areas. The difference between staying healthy and falling ill could come down to something as simple as the city you were raised in. 

Neighborhood and Built Environment

Built environment is defined as all the man-made or modified structures that give people living, working, and recreational spaces. These can encompass anything from nearby roads and bridges to the water and electricity systems. 

The Oregon Health Study conducted by the Robert Wood Johnson Foundation found that a neighborhood’s built environment can immensely impact residents’ health, especially in terms of access to grocery stores and nutritional food, proximity of fast-food restaurants, and crime rate. Similar to a location that is located far away from healthcare resources, not having the access to healthy food or clean, safe spaces can have an enormous negative effect on one’s health. 

The study also found correlation between the racial and ethnic composition and various characteristics of a neighborhood. It is unfortunate to acknowledge that oftentimes communities of color and historically oppressed minorities live in poorer or more unsafe neighborhoods. This is frequently the result of numerous social determinants of health stacked together, and reveal the deep discriminatory issues of our healthcare system. 

Social and Community Context

Social and community context can be defined as the social settings in which people live and act, especially in regards to one’s social relationships and the various institutions they interact with. Feeling a sense of community and belonging is critical to having a positive experience and better health overall.  

In particular, racial and ethnic discrimination can strongly influence one’s sense of social cohesion and affect health outcomes in the future. Not feeling supported and safe can negatively impact one’s well-being and continually set individuals behind if they continue to face similar conditions. This means that for people of color and minority groups, experiencing racism in their day to day lives even in the smallest micro-aggression could mean they end up losing their lives earlier than a privileged white male. 

Economic Stability

Unsurprisingly, economic stability or instability can be another major contributing factor to one’s health. Employment is directly correlated with one’s health, and a lack of employment can actually be linked to higher risks of illness and premature death. Furthermore, those who are unemployed are less likely to receive adequate medical care and prescriptions in comparison to those who are employed.  

There is also evidence that unemployment is related to health risk behaviors such as binge drinking, obesity, smoking, etc. These risk behaviors lead to a higher chance of contracting diseases, experiencing organ failure, bodily pain and aches, etc. Not being able to find a secure job could lead to a domino effect of health-related complications: not being able to afford services, unable to pay for higher-quality nutritional food, being forced into a neighborhood that faces higher pollution, and more. The determinants of health often interact and overlap in this manner, shaping and warping an individual’s health long before they even start being cognizant of their own well-being. 

What Does It All Mean?

Despite the close association health has with medicine, the various social determinants of health prove that an individual’s health can be severely influenced by non-medical factors that are typically out of one’s control. Whether it be access to healthcare, education, location, community, or economic status, all these determinants compounded and piled together can drastically set someone back and hinder their ability to gain medical resources or simply lead a safe and healthy life. 

The flaws in our healthcare system are made evident with a simple comparison: consider a young, African-American boy living in a dangerous, low-income neighborhood far away from grocery stores and located in an understaffed school district. On the other hand, turn to a young white man living in an affluent suburban town, with regular access to stores like Whole Foods along with a school district that has historically sent countless kids to Ivy League schools. Who out of the two is going to live for longer? 

Unfortunately, many of these factors and determinants are frequently out of an individual’s control. Oftentimes, systemic oppression bleeds into the healthcare system and makes it difficult for those who have historically struggled to advance or progress in society. So what can we do? 

Solutions

Experts in public health are continually on the search for solutions and methods to combat the inequity given by social determinants of health. A few commonly discussed ideas are:

1. Creating programs to specifically give opportunities to minorities and historically disadvantaged communities.

2. Training for employers to avoid racial/ethnic/gender bias in their work, seeking to push towards more equal treatment of all individuals in the healthcare system. 

3. Incorporating more education about cultural competency and social determinants in higher level healthcare schools such as medical school, PA school, etc. 

The American Academy of Family Physicians has also proposed a team-based approach to advance health equity, which establishes a general framework for how different social determinants of health can be targeted. Their approach consists of three key steps: identifying opportunities to address SDOH, evaluating patient and workflow, and finally identifying community-based resources. 

It is crucial to educate ourselves about the social determinants of health in order to gain a holistic understanding of different people’s backgrounds, access to resources, and hardships they face in attaining healthcare. The impact that various non-medical and often uncontrollable factors can have is immense; shining a light on the social determinants of health reveals just how flawed our healthcare system is, as well as how systemic oppression continues to plague so much of daily life. 

If we seek to reform our healthcare system, we cannot continue working within its confines. Rather, it takes radical change and actively working against the system to truly perpetuate change, and begin bridging the aching gaps in health equity that the United States continues to face.