Implementation Considerations for SDOH Programs Serving Racial and Ethnic Minority Populations and Tribal
Addressing social determinants of health (SDOH) among racial and ethnic minority populations and tribal
communities may require additional considerations. This section describes unique considerations for these
specific rural groups related to SDOH programs.
Preparing Rural Communities to Address SDOH for Racial and Ethnic Minority Populations
Addressing SDOH among rural minority populations may involve training rural program staff and partners —
particularly those working in healthcare services — in issues of cultural and structural competence. Cultural competence involves
understanding the ways that culture and language can influence health beliefs and outcomes. Structural competence involves understanding how health
outcomes are affected by SDOH and preparing to act on the root causes of inequities. This could include learning
about influences on health, such as the historical context and current issues that
affect local communities, joining cross-sectoral efforts to
address SDOH, and integrating an SDOH assessment tool
into healthcare interactions.
Addressing racial and ethnic health disparities in rural areas also requires recognizing how racism interacts
with SDOH. According to the Institute of Medicine's Unequal
Treatment Report, health outcomes among African American patients were found to be worse than those of
White patients, even after accounting for income, neighborhood, comorbid illness conditions, and health
insurance type. Rural communities engaging in SDOH projects may need to understand the impact of implicit bias, which refers to
unconscious assumptions that can influence perspectives of and action toward others. Implicit bias can affect
the way that many people, including those who work in education, the criminal justice system, and healthcare,
interact with racial and ethnic minority populations.
Understanding the Intersection of Trauma and Inequity
Health inequities can arise from actions and policies that have harmed and continue to disproportionately burden
racial and ethnic minority populations. Race-based discrimination, social exclusion, and violence can contribute
to traumatic outcomes. This includes historical and intergenerational
trauma, concepts that are particularly pertinent to American Indian and Alaska Native communities. This mass
trauma can manifest in physical and behavioral symptoms, which affect the health and well-being of future
generations. Research shows that African American and Hispanic/Latino populations are also disproportionately exposed
to traumatic events. For example, African American and Hispanic/Latino children are more
likely to experience adverse childhood experiences than White or Asian children.
Rural communities can take action to build trauma-informed
programs, organizations, and communities. Key principles of trauma-informed practices include:
Promoting the safety of community members
Creating trust and promoting transparency between affected populations and program staff
Facilitating interactions and mutual support among peers and trauma survivors
Recognizing power dynamics and establishing a commitment to collaboration and respect
Prioritizing the active involvement of affected populations in their healing and recovery through
Acknowledging the intersection between trauma, racism, and discrimination, and responding to
cultural needs and perspectives of affected populations
Promoting Participation and Leadership
One of the root causes of racial health inequities
is structural barriers that limit participation in policymaking and decision-making. Addressing these inequities
will require involving affected community members in SDOH programs and promoting their ability to shape program
design, goals, priorities, strategies, communications, and interpretation of findings.
When working with tribal communities, rural program planners should understand the importance of
securing buy-in from the tribe and involve members in every step of the planning and implementation
process. Rural programs have reported the need to work with and engage multiple generations within a
tribal community, including youth, parents, and elders.
Resources to Learn More
Bodies Don't Just Tell Stories, They Tell
Histories: Embodiment of Historical Trauma among American Indians and Alaska Natives
Describes the way that historical traumatic events continue to influence health inequities among American
Indian/Alaska Native communities.
Author(s): Walters, K.L., Mohammed, S.A., Evans-Campbell, T., Beltrán, R.E., Chae, D.H., &
Citation: Du Bois Review: Social Science Research on Race, 8(1), 179-189
Impact on Rural Multiracial and Multicultural Populations Related to the Devolution of Welfare
Describes the way that restrictions in federal public assistance programs have disproportionately harmed rural
communities and in particular, rural multiracial and multicultural residents.
Organization(s): National Rural Health Organization
Social Determinants of Health among African Americans in a
Rural Community in the Deep South: An Ecological Exploration
Discusses SDOH that affect a sample of African Americans living in rural southeastern Georgia. Discusses factors
that affect health at several levels of society, from the individual to the structural (for example, race
relations and poverty).
Author(s): Scott, A.J. & Wilson, R.F.
Citation: Rural and Remote Health, 11(1), 1634
Place and Race Matter: Impacting Health Through a Focus on Race and Place
Describes the influence of neighborhood environmental factors, such as the physical environment and economic
opportunities, on the health of people. Discusses how people of color are disproportionately affected by factors
that lead to negative health outcomes. Includes examples from rural communities, including rural portions of
Shasta County, CA.
Author(s): Bell, J. & Lee, M.M.
Organization(s): The California Endowment and PolicyLink