What are the social determinants of health?

When you think about supporting the health of your patients and building a healthier community, what comes to mind? A robust medical staff? Great technology? A beautiful new hospital facility? A wide range of healthcare services?

Of course, all these things contribute to good health. But the building blocks of a truly healthy community must include consideration of the social determinants of health (SDOH) – the cultural and environmental factors that drive health – or lack thereof.

There are many models of SDOH – but I prefer the construct offered by Healthy People 2020 (with just a few minor adaptations of my own.) Here is what the model looks like:

The Healthy People 2020 model organizes SDOH into five main “place-based” domains:

  1. Healthcare: Means access to primary care and healthcare services, as well as health literacy.
  2. Education: Extends from early childhood development, through high school graduation and on to enrollment in higher education.
  3. Social & Community Context: Involves civic participation (voting, volunteering and the like), discrimination, incarceration and social cohesion (social networks, support and capital).
  4. Neighborhood & Built Environment: Includes access to nutritious foods, the quality of housing, crime and violence and environmental conditions (water, air and temperature).
  5. Economic Stability: Refers to poverty, employment, food insecurity and housing instability.

In addition to the five basic domains, I believe there are two more determinants of health that warrant our attention:

  1. Genes & Biology: Every individual possesses a unique health profile based on their biological and genetic makeup, which includes race and ethnicity. These characteristics present varied levels of physical risk, e.g. African-Americans are more likely to suffer stroke, while Caucasians are at greater risk for skin cancer. But we also must recognize the social ramifications such as discrimination and health disparities.
  2. Health Behaviors: Health habits may result from personal choice, but they are also affected by cultural norms, social influence, religious beliefs and the like.

When you put it all together, it becomes evident that elevating the health status of our communities means looking beyond the walls of our healthcare institutions. We must also consider the cultural, social, environmental, economic and educational issues that can contribute to illness, injury, chronic disease and early death or support a thriving, healthy community.

In future articles we will do a deeper dive into SDOH and look at best practices around the country–healthcare organizations that are making a significant difference by viewing health through a social lens.

To learn more about population health strategies and marketing’s role in promoting health improvement, visit pophealth.ndp.agency.

Susan Dubuque is a principal and co-founder of NDP and a nationally recognized expert in health care and behavioral marketing. She literally wrote the book on marketing’s role in health improvement — Gearing up for Population Health: Marketing for Change — published by the Society for Healthcare Strategy and Market Development of the American Hospital Association (2018).

Reference | Secretary’s Advisory Committee on Health Promotion and Disease Prevention Objectives for 2020. Healthy People 2020: An Opportunity to Address the Societal Determinants of Health in the United States. July 26, 2010. Available from: http://www.healthypeople.gov/2010/hp2020/advisory/SocietalDeterminantsHealth.htm