By Michelle Li
Published 11:30 EST, Thurs December 23rd, 2021
Social determinants of health (SDOH) are specific environmental factors in the lives of individuals that affect future health risks and outcomes. Health 2030, the current iteration of the Healthy People Initiative that sets a framework of health objectives for each decade, outlines five categories of social determinants of health: economic stability, healthcare access and quality, education access and quality, social and community context, and neighborhood and built environment (“About Social Determinants of Health (SDOH)”). Each determinant contributes to existing health inequities and is interconnected, as they can compound on each other to have a greater impact on health. The WHO estimates that these SDOH are responsible for 30-55% of health outcomes (“Social determinants of health”). In recognition of these factors, screenings for social determinants of health have been introduced to inform healthcare decisions, providing hope for addressing those determinants, although not a full answer.
Economic stability is one of the most influential of the social determinants, as it also directly influences other determinants and aspects of life. Income, employment, cost of living, food security, housing stability, poverty, and other factors related to socioeconomic status are considered in relation to health. Many have found that health and illness follow a social gradient, where lower socioeconomic positions lead to worse health. This is expected, as higher socioeconomic positions translate to a greater ability to fulfill basic needs (food and housing for instance) as well as pay for healthcare and education, which have more long-term effects in improving health and quality of life.
Healthcare Access and Quality
Healthcare access and quality, another important determinant, covers factors such as access to healthcare or primary care, health insurance coverage, and health literacy. Those without health insurance are less likely to have access to a primary care provider. This leads to even greater consequences, as health issues may go unnoticed and necessary health care services (such as cancer screenings) may not be carried through. Additionally, the care provided to pregnant women before, during, and after birth can reduce pregnancy-related risks for both the child and mother, making access to quality healthcare even more important when considering child health.
Education Access and Quality
Education access and quality are also connected to health. This determinant concerns graduation from high school, enrollment in higher education, language literacy, and early childhood education. Those with higher levels of education experience healthier and longer lives, while others without access to education have fewer opportunities for safe and higher-paying jobs, circling back to the correlation between income level and increased likelihood of health problems.
Social and Community Context
Social and community context refers to the impact of relationships and interactions with other people on health and well-being. Individuals often draw support from their relationships with other people, and this becomes a more influential problem when considering young children and their relationships with parents or others that are close to them. While it is also true of adults, there is a greater potential of these relationships (or absence of these relationships) damaging well-being and mental health of young children, specifically in the form of early trauma that can have long-lasting impacts. Social and community context also takes into account incarceration and crime, adolescent bullying, discrimination, conditions in the workplace, cohesion within a community, and civic participation.
Neighborhood and Built Environment
The determinant of the neighborhood and built environment encapsulates the factors of housing, neighborhood, and environment and their connection to health and safety. Access to housing, rates of violence, noise levels, and exposure to second-hand smoking are considered. Some factors are more specific to the environment, such as pollutants/allergens and lead ingestion specifically. Both of these are large issues that adversely affect child health, as they can affect brain development and exacerbate asthma, showcasing the potential detriment of the impacts of the neighborhoods and the built environment.
In response to the rise in prevalence and recognition of these determinants, screenings have arisen to identify and address the social needs of patients. There is a range of different types of screenings—such as the “HealthBegins Upstream Risks Screening Tool” and Kaiser Permanente’s “Your Current Life Situation (YCLS) Survey”—but at their basis, each consists of a set of questions asking about the effects of certain social health determinants on the lives of patients. Some tools are also separated into adult and pediatric versions to better gauge the situations of the two different age groups. In this way, insight into the environment and experiences of patients is gained and addressed in the form of community-level resources and care. The provided resources vary from farmer’s markets in food deserts to affordable housing, but it is the SDOH screenings that identify determinants that need to be addressed and allow for appropriate resources to be distributed to specific communities.
Social determinants of health are critical to individuals as well as communities and public health. The five categories of social determinants of health—economic stability, healthcare access, education access, social and community context, and neighborhood and built environment—greatly impact health risks and outcomes and can compound on each other to cause greater consequences. SDOH screenings can be used to respond to the determinants affecting a specific community in the form of different resources to relieve a portion of the stress from those determinants. Ultimately, though, social determinants of health are long-rooted problems that affect many communities and groups of people disproportionately and will require a consistent and even greater response in order to be eliminated and effect health equity.
Michelle Li, Youth Medical Journal 2021
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