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Defining the Social Determinants of Health

Health and well-being is influenced by many factors outside of the medical care we receive, including the places where we grow up and the places where we work. These factors, the social determinants of health (SDOH), can impact the health and well-being of entire communities. Organizations and agencies use different definitions of SDOH. This highlights the complex nature of the multiple environments, systems, and policies that affect health.

Healthy People 2020 defines SDOH as:

Conditions in the environments in which 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.

The World Health Organization describes SDOH as:

Conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.

The Robert Wood Johnson Foundation states:

Good health begins in the places where we live, learn, work and play. Although medical care is critically important, things like the quality of our schools, affordability and stability of our housing, access to good jobs with fair pay, and the safety of our neighborhoods can keep us healthy in the first place.

Social Determinants, Health Disparities, and Health Inequity

SDOH are closely linked with health outcomes. Research suggests that the number of deaths in the U.S. due to social factors — such as a lack of education, racial segregation, discrimination, and poverty — may be comparable to the number resulting from heart disease, lung cancer, and other leading causes of death.

In addition, SDOH can influence and contribute to chronic health conditions, such as obesity, diabetes, and heart disease. For example, people who have low incomes may be more likely to live in food deserts that lack access to nutritious foods and result in higher rates of obesity. They may also face several barriers to accessing healthcare, including lack of health insurance.

SDOH also contribute to health disparities. Health disparities are differences in health between groups of people, and these differences are often related to social and economic factors that negatively impact health. Health disparities can occur when people are disadvantaged as a result of personal characteristics or circumstances, such as race, socioeconomic status, or geographic location. For example, research demonstrates that in some areas of the U.S., people are much healthier than in other areas. Average life expectancy varies by county, zip code, and census block. When compared with urban populations, rural populations experience health disparities due to challenges in accessing healthcare as a result of provider shortages, geographic barriers, and limited transportation infrastructure in rural areas. Other rural SDOH that impact health outcomes include the fact that rural residents have lower incomes, are more likely to live in poverty, and have lower educational attainment when compared with urban populations.

Health disparities can result in health inequity, which the World Health Organization describes as:

differences in health status or in the distribution of health resources between different population groups, arising from the social conditions in which people are born, grow, live, work and age. Health inequities are unfair and could be reduced by the right mix of government policies.

Health disparities represent a lack of health equity, which occurs when everyone has the same opportunity to live a long and healthy life. Many health inequities are caused by SDOH and are the result of unequal conditions in the social and physical environment in communities that have a negative impact on health.

Health and well-being, according to the National Association of County & City Health Officials, can also:

be influenced by differences in power as they are reflected in social constructs such as class, race, gender identity, and sexual orientation.

Health inequities can result from racism, discrimination, and historical traumas experienced by communities, including the forced relocation of Native Americans. Historical trauma is a concept that researchers identify as experiences, shared by communities and inflicted on groups of people because of their race, creed, and ethnicity, that results in emotional and psychological wounds that can be passed down through generations of people.

Health professionals are assessing the influence of SDOH to better understand how to make policy, systems, and environmental changes that improve health and well-being and address health inequities. Addressing SDOH means targeting the root causes that can contribute to poor health. Several SDOH that impact health and well-being include:

  • Racism and discrimination
  • Income and poverty
  • Housing quality and affordability
  • Access to transportation
  • Education
  • Access to healthcare services
  • Employment and financial opportunities
  • Social support
  • Availability of safe streets and green space
  • Access to nutritious foods

Resources to Learn More

Addressing Social Determinants of Health and Development
Website
Provides information about social factors influencing health and development outcomes, and identifies strategies for addressing social determinants of health.
Author(s): Fawcett, S. & Rabinowitz, P.
Organization(s): Community Toolbox, Center for Community Healthy and Development at the University of Kansas

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity
Document
Presents an overview of SDOH and identifies promising strategies and interventions to address social determinants in different settings.
Author(s): Artiga, S. & Hinton, E.
Organization(s): Henry J. Kaiser Family Foundation
Date: 5/2018

Communities in Action: Pathways to Health Equity
Document
Defines health equity, inequity, and disparities, and discusses the elements for addressing health disparities and promoting health equity, including community-supported solutions, and public and private policies.
Organization(s): National Academies of Sciences, Engineering, and Medicine
Date: 2017

Health Equity
Website
Compiles resources, presentations, and training materials to help people understand and better address concepts of health equity, health inequality, and SDOH.
Organization(s): American Planning Association, American Public Health Association

Historical Trauma and Microaggressions: A Framework for Culturally-Based Practice
Document
Defines and describes historical trauma and microaggressions experienced by American Indian/Alaska Native (AI/AN) people with a focus on children. Discusses the intergenerational transmission of the traumatic events and high levels of distress in contemporary AI/AN communities.
Author(s): Michaels, C.
Organization(s): Center for Excellence in Children's Mental Health, University of Minnesota
Date: 10/2010

A New Way to Talk About the Social Determinants of Health
Document
Discusses the results of research conducted to develop common language associated with SDOH to help the public understand the concept of SDOH with the goal of expanding their views about what it means to be healthy.
Organization(s): Robert Wood Johnson Foundation
Date: 2010

Social Determinants of Health: Know What Affects Health
Website
Provides SDOH data, research, and policy resources, and includes CDC-funded public health programs and guidance documents for addressing SDOH.
Organization(s): Centers for Disease Control and Prevention