Social determinants of health (SDH) are non-medical issues that affect your health and life expectancy. Some examples include your income, job, education level, and ZIP code. Many SDHs are beyond your control. But with the support of health professionals and community organizations, you can access the resources your family needs to stay as healthy as possible.
What are social determinants of health?
Social determinants of health (SDH) are the personal, social, and environmental factors that influence your health and well-being. They include things like your income, where you live, and the resources available in your community. SDH are all the non-medical aspects of your life that you may not consider when talking to your doctor because you don’t understand how they relate to your health.
However, research shows that SDH are not only related to your health, but can also influence it. This means they affect your risk of developing certain diseases, the medical care you have access to, and how you feel on a daily basis.
For example, having a stable income and health insurance can help you buy healthy foods and get regular checkups. Owning a car can make it easier to get to doctor appointments or pick up medications.
However, working without paid time off or living far from a grocery store without reliable transportation can make it very difficult to do activities necessary to stay healthy, such as eating fresh food or visiting your primary care doctor regularly.
What are some examples of social determinants of health?
Social determinants of health (SDH) include:
- Your income.
- Your educational level
- Your job and benefits, such as health insurance and paid time off.
- The availability of resources in your community, such as nutritious food, public transportation, and childcare.
- Your sense of safety in your community.
- Access to health care.
- The quality of the air you breathe and the water you drink.
- Your relationships and social connections.
These are just a few examples. SDHs are present everywhere you live, work, and spend time. It’s helpful to divide SDH examples into groups, or what researchers call domains.
According to the U.S. Department of Health and Human Services, these are five domains of SDHs:
- Economic stability: Factors related to your income and your income’s ability to cover your family’s health and other needs. Access to and quality of education: Factors related to the education you receive and its ability to meet your individual learning needs, including those related to brain function.
- Access to and quality of health care: Factors related to the health care you receive and its ability to meet all of your physical and mental health needs.
- Neighborhood and environment: Factors related to your zip code or the specific community in which you live, including the resources that keep you healthy and safe.
- Social and community context: Factors related to your relationships with family, friends, coworkers, and community members.
Social Determinants of Health
It’s important to remember that all of these factors interact and influence each other. For example, poverty affects every aspect of your life, from what you eat to where you live and the resources you can access. When you have children, a lack of affordable childcare can affect your ability to work. In a neighborhood without public transportation or sidewalks, it’s difficult to buy food or go to the doctor.
In other words, the social determinants of health don’t exist in isolation, and even one or two barriers can have a domino effect on your life and health.
So, what does all of this mean for you? How do you know which social well-being factors influence your life? Consider the following questions, grouped by areas of social well-being. Ideally, you should be able to answer “yes” to all of these questions. Write down the questions you answered “no” to. These are topics you may want to discuss with a loved one, a mentor, or a doctor.
Financial Stability
- Do you have enough money to buy nutritious food?
- Can you afford medical care, including doctor visits and medications?
- Do you have enough money for housing?
- Do you have enough money to pay utilities and other bills?
- Do you have access to affordable childcare?
- Do you feel job security?
- Does your employer offer health insurance?
- Does your employer offer paid vacation or sick leave?
- If you are unemployed, do you have access to programs to help you find work?
- Do you have access to career guidance?
Access and Quality of Education
It can be very helpful to think about the resources available to your child (current or future) in this regard. You can also consider their past or current educational experiences.
- Does your child have access to a quality education from preschool through 12th grade?
- Does your child have a chance to graduate from high school?
- Are there resources to meet your child’s individual needs, such as support for children with learning or intellectual disabilities?
- Does your family have the resources to send your child to college or vocational school?
- Does your child have good relationships with peers at school?
Neighborhood and Built Environment
- Can you easily get to a well-stocked supermarket?
- Do you have access to a farmers market or other source of fresh produce?
- Do you have internet access?
- Do you feel safe at home?
- Do you feel safe in your neighborhood?
- Are there sidewalks in your neighborhood?
- Are there bike paths?
- Does the tap water contain fluoride?
- Is your housing affordable? (Affordable, no more than 30% of your income.)
- Is your home lead-free?
- Is the street quiet enough to sleep?
- Does your building accommodate your mobility needs? (For example, are there ramps or elevators?)
Why do social determinants of health matter?
Social determinants of health matter because they can increase or decrease your risk of developing a variety of diseases, influencing how long you live. They are so powerful because they influence how your genes work and the choices you make every day. Let’s take a closer look.
Social determinants of health and your genes
Your genes influence your risk of developing diseases. For example, you may have inherited a genetic mutation (such as a change in the BRCA1 or BRCA2 genes) that increases your risk of developing cancer. Or perhaps your biological relatives have a history of cardiovascular disease, making you more likely to develop heart disease.
But inherited genetic mutations are only part of the story. Researchers studying epigenetics are just beginning to understand how your environment influences how your genes work. We’re seeing how everything from how you were raised as a child to the quality of the air you breathe can turn certain genes on or off.
These epigenetic changes are not the same as genetic mutations — your DNA sequence stays the same. But your genes don’t work the way they’re supposed to. They’re like the light bulbs in your light fixtures, but there’s no one there to turn them on.
Genes that are on when they’re supposed to be off, or off when they’re supposed to be on, can cause all sorts of harmful changes in your body. Tumor growth is one example. This means that the social determinants of health (like your social relationships and environmental toxins) can affect your genes — the parts of you that always seemed immutable.
SDOH and Your Choices
In addition to genetics, your choices also show a role in determining your risk of developing diseases. You can’t change your inherited risk factors. But knowing that you’re at risk can motivate you to make certain choices — like getting screened for cancer, eating a Mediterranean diet, or getting your blood pressure checked regularly. All of these things can help reduce your risk of developing certain diseases or increase your chances of getting treatment early and surviving.
But is the choice really up to you? Often, not. You may have obstacles in your way, like not having transportation to get to your doctor’s appointment or not having enough income to buy healthy foods. Willpower can only go so far.
In an ideal world, everyone would have access to high-quality resources and opportunities to stay healthy. We’re not there yet, but understanding how social determinants of health affect you is the first step toward leveling the playing field. Health care providers use a variety of screening tools to learn how health issues affect you and what you can do to help.
What is a social determinants of health screening tool?
SDOH screening tools are surveys or questionnaires that you fill out before you see your doctor. For example, you might fill out an online form before you see your primary care doctor. The form will ask you about different aspects of your life, such as housing, relationships, and access to food. The questions may be similar to those listed earlier in this article. Your doctor can discuss your answers during your appointment.
The more comfortable you feel, the more they can help you. They can discuss possible solutions to your problems or connect you with community resources. There may be other things going on in your life that weren’t covered on the form. If so, mention them to your doctor when you see them. If your doctor can’t help with a specific problem, they can refer you to someone who can.
Overview
Social determinants of health begin to affect you from the time you’re born and continue to shape your health as you get older. Some factors may change over time. For example, you may have a steady income for a while and then suddenly lose your job. Or you may move from an area with good bus service and sidewalks to an area where it’s unsafe to drive and you may not be able to afford one. Factors that once supported your health may suddenly undermine it.
But the opposite can also happen. You may go for years without health insurance or paid time off and then find a job that offers both, plus the opportunity to move to a house on a quiet street where you can finally get a good night’s sleep. Life is made up of many variables, and the factors that affect your health are not set in stone.
This means that the obstacles you may be facing now may not be permanent. If you don’t have access to the resources you need to stay healthy, reach out to your doctor or a community organization, such as a church or nonprofit. They can give you advice and support, and refer you to others who can help.