Episode 189: The Social Determinants of Health: Why We Are Focusing On The Wrong Things
“We wait for people to break down and park ambulances at the bottom of the cliff.”— Dr. Corey Keyes, Professor of Sociology, Emory University
Introduction
When we think of factors that contribute to our health, we often think of clinical aspects such as genetics, diet, exercise, substance use, age, etc. Social determinants of health (SDOH) encompass all the other non‐medical aspects that affect our health, such as income, coping skills, culture, workplace conditions, housing, racism, access to healthcare, the built environment, social experiences, social support, and more. Since we tend to focus more on the clinical side of health, health systems often wait for problems to occur and then treat the diseases, broken bones, etc., rather than taking a preventative approach. What if systems are focusing on the wrong things? What if we can improve health outcomes by addressing the social determinants of health?
A Brief Intro into Social Determinants of Health
Table of Contents
- Understanding the Social Determinants of Health
- Current Policies
- SDOH in Action: A Case Study
- How to Take Action
Understanding the Social Determinants of Health
The social determinants of health include the social and environmental factors that affect health outcomes rather than medical factors. Since these items are not medical, it can be difficult to conceptualize and measure how they influence health.
Current Policies
There are two approaches to creating policy: an upstream approach or a downstream approach. The downstream approach is reactive, enacting policies to address issues that have already occurred. The upstream approach prevents issues from developing in the first place. Most policies are reactive, but by addressing the social determinants of health, policies can target the very patterns that create these issues, preventing them from happening.
Up until 2021, there was no dedicated branch in the USA addressing SDOH. The American Rescue Plan Act of 2021 addresses social determinants such as healthcare access and social vulnerabilities. In 2012, 53 EU members adopted Health 2020 to address population health, reduce inequities, and improve outcomes.
SDOH in Action: A Case Study
The socioecological model allows for both multi‐pronged and singular interventions. Papa pairs underserved people (older adults, families, etc.) with a trained “Papa Pal” who assists with transportation to appointments, grocery shopping, companionship, and more. Participants were assessed in 2019 and at six‑month intervals thereafter. The chart below shows a 31% reduction in mentally unhealthy days and a 38% reduction in physically unhealthy days.
How to Take Action
Addressing SDOH can create profound and lasting change. Actions range from individual volunteerism (e.g., at Papa) to advocating for supportive policies at local and federal levels. Organizations can implement similar programs, and governments can pass policies that foster positive change.
Public Health Insight Podcast: Social Determinants of Health
Listen to our full episode:
Key Takeaways
- Social determinants of health encompass non‐medical factors like environment, finances, and social support.
- Addressing SDOH can help reduce health disparities.
- Effective action requires both policy and community‐level interventions.
References
- Donkin, A., Goldblatt, P., et al. (2017). Global action on the social determinants of health. BMJ Global Health.
- Golden, S. D., & Earp, J. A. L. (2012). Social ecological approaches to individuals and their contexts. Health Education & Behavior.
- American Rescue Plan Act of 2021.
- Pandemic-Driven Health Policies to Address Social Needs and Health Equity.
- Rudy, E. T., et al. (2022). A call for consistent measurement across the social determinants of health industry landscape. Population Health Management.
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