Frameworks to Address Social Determinants of Health
Both the U.S. and other countries recognize the importance of addressing social determinants of health (SDOH) as
part of improving overall health and well-being. Several SDOH
frameworks have been developed to help communities, health professionals, and others begin to better
understand and address a variety of factors that affect health. This toolkit explores different aspects of SDOH
— with a primary focus on the Healthy
People 2020 and the World Health
Organization (WHO) SDOH frameworks — and identifies promising approaches and evidence-based models to
help rural organizations address SDOH to improve quality of life.
WHO Conceptual SDOH Framework
Conceptual SDOH framework demonstrates how social, economic, and political factors such as income,
education, occupation, gender, race, and ethnicity influence a person's socioeconomic position which, in turn,
plays a role in determining health outcomes. These factors can influence a person's ability to lead a healthy
life, influencing things such as quality of housing, opportunities in the built environment that encourage
physical activity, and access to healthcare services. In this framework, SDOH are categorized into two broad
types that work together to impact health and well-being. These determinants are “structural
determinants,” which include socioeconomic status and community/societal context, and “intermediary
determinants,” which include the living and working conditions of people.
Healthy People is an initiative that sets national
objectives each decade to help monitor and improve the health of the U.S. The initiative aims to identify key
areas important for improving health, and to develop objectives that communities can use to measure progress
towards achieving health goals. For Healthy People 2020, a continuation of the Healthy People initiative that
set nationwide health objectives for 2010 through 2020, a framework was developed that organized SDOH into five
areas. Using these five key areas, this toolkit looks at evidence-based and promising approaches rural programs
can use to address SDOH in communities. These domains are programs that address changes to:
Social and community context
Health and healthcare access
The neighborhood and built environment
Within each of these domains, Healthy People 2020 outlines important SDOH. For example, within the domain of
economic stability are factors such as employment, food insecurity, housing instability, and poverty.
Ecological perspectives of SDOH
acknowledge the interaction of several levels of individual, interpersonal, institutional, policy, and
structural factors that affect health and well-being. One rural
adaptation of an ecological model in an African American community categorizes SDOH into five areas:
individual traits and behaviors, relationships and social support, built environment, laws and policies, and
“superstructural” social issues such as racism and sexism.
Another ecological framework adopted by the California
Department of Public Health recognizes the complex interactions between many factors that were
previously not considered to impact health outcomes, with a particular focus on improving health equity.
Different communities and programs have also adopted the Social-Ecological
Model as a framework to address social determinants of health. This approach looks at addressing
different levels of social and structural factors that influence health and well-being.
Rural Community Health & Well-Being Framework
Canadian researchers from the Rural Development Institute have also developed a rural-specific framework to
describe SDOH and factors that make up healthy communities. The Rural
Community Health and Well-Being Framework identifies social, economic and environmental factors as key
drivers of health in rural communities, but adds ten additional categories that rural residents have highlighted
as important factors in determining health and well-being. These additional categories include:
- Safety and security
- Community infrastructure
- Recreation/heritage and arts
- Community processes
- Social supports
Resources to Learn More
Framework for Action on the Social Determinants of Health: Social Determinants of Health Discussion Paper
Describes how the conceptual framework for understanding the SDOH was developed by the Commission on Social
Determinants of Health. Identifies the elements of policy action and policy implications for addressing
Author(s): Solar, O. & Irwin, A.
Organization(s): World Health Organization
Framework for Educating Health Professionals to Address the Social Determinants of Health
Outlines a framework for teaching health professionals during their initial training and through
professional development on how to address SDOH.
Organization(s): Institute of Medicine, National Academies of Sciences, Engineering, and Medicine
Michael Marmot and the Social Determinants of
An interview with Michael Marmot from University College London discussing several key concepts related to SDOH
and health equity.
Organization(s): American Public Health Association
to Catalyze Comprehensive Community Wellness: An Actionable Framework for Health Care and Public Health
Describes a shared vision and framework for collaboration and coordination between public health and
healthcare sectors working together to improve U.S. health and well-being.
Organization(s): Health Care Transformation Task Force, the Public Health Leadership