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Rural Health Information Hub

Types of Social Determinants of Health

This section provides an overview of several different types of social determinants of health (SDOH) and factors that contribute to the health of rural communities. Using the Healthy People 2030 SDOH place-based framework, these SDOH are organized into five categories. For more information about each of these domains, see Program Models in Module 2.

Economic stability is related to employment status and the ability to earn a reliable and livable income. Economic stability also includes factors that relate to safe and affordable housing and access to healthy and affordable foods. The main factors that comprise economic stability include:

  • Employment and the work environment
  • Food access and food security
  • Safe and affordable housing
  • Income/poverty and financial resources

Educational attainment is another important SDOH. Early and continued education of a child can have a positive impact on his or her health and well-being later in life. A focus on early childhood education and development is particularly important for improving health outcomes. This SDOH domain includes language development and literacy. In urban areas, increasing college graduation rates can improve community outcomes, but this approach may not have the same impact in rural areas. Rural residents who leave their community to attend four-year colleges often do not return to work in the community. This is one of several important considerations for programs addressing SDOH in rural communities.

The social and community context in which people live includes the relationships formed between neighbors, as well as the impact that voting and civic engagement has on community outcomes. Several SDOH that are included in this domain are:

  • Civic participation
  • Discrimination
  • Incarceration
  • Social cohesion

Access to healthcare has a direct impact on health outcomes and quality of life, and several factors can both facilitate and hinder access, such as health insurance coverage, distance to healthcare settings, and the availability of health providers. Aside from access to health services, other SDOH that fall within the healthcare domain include health literacy and the provider workforce. For more information, see RHIhub's Healthcare Access in Rural Communities topic guide.

Neighborhoods and built environment can also influence the health of rural communities. Sidewalks, bicycle lanes, walking trails, and green space in communities can improve physical activity and promote healthier living. In addition, a lack of attention to accessibility features in the design of community spaces can limit access for older populations and people with disabilities.

Several SDOH that are related to neighborhood and built environment factors include:

  • Crime and violence
  • Environmental conditions
  • Access to transportation

Resources to Learn More

CDC Research on SDOH
A compilation of evidence-based models and promising approaches for improving health equity based on the Healthy People 2020 SDOH framework. Includes resources on economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.
Organization(s): Centers for Disease Control and Prevention