The Social Determinants of Health: Why are we 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 of health 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
In this blog post, we’ll be outlining
- 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 affecting health. Since these items are not medical, it can be difficult to conceptualize and measure how they influence health.
https://communicatehealth.com/wehearthealthliteracy/useful-theory-social-ecological-model/#
This illustration shows the socioecological model of health and how a multilevel approach describes the social determinants of health (Golden & Earp, 2012). The boxes closest to Fred are the factors directly affecting him on a personal level. As the boxes get further away, those represent levels of influence that encompass the larger social system and community as a whole.
Current Policies
There are two approaches to creating policy: an upstream approach or a downstream approach. The downstream approach is a reactive approach where policies are enacted to address an issue that has already occurred.
The upstream approach prevents issues from developing in the first place. Most policies are reactive to problems already occurring, but by addressing the social determinants of health, policies can address the very patterns that create these issues, preventing them from happening in the first place. Up until 2021, there was no dedicated branch to addressing the social determinants of health in the USA (Pandemic-Driven Health Policies to Address Social Needs and Health Equity | Health Affairs Brief, n.d.).
The American Rescue Plan Act which was passed in 2021 is unique because it addresses social determinants of health such as healthcare access and other social vulnerabilities (H.R.1319 – 117th Congress (2021-2022): American Rescue Plan Act of 2021, n.d.). In 2012, 53 members of the EU adopted Health 2020 to address population health, reduce health inequities, and improve health outcomes (Donkin et al., 2017). These policies are a great start and represent a shift in how we think about creating positive health outcomes.
SDOH in Action: A Case Study
The socioecological model allows for interventions to have a multi-pronged approach or a singular approach (Golden & Earp, 2012). Interventions can target individual behaviors, community influences, the environment people live in, or the policies that make sweeping changes in people’s lives and more. Papa is a program that addresses the SDOH by pairing underserved people such as older adults, families, etc with a trained individual (Papa Pal) to help with everyday activities. A Papa Pal can help with tasks such as transportation to medical appointments, grocery shopping, and even companionship. Participants underwent an initial assessment in 2019 to determine baseline metrics and were then assessed at biyearly intervals (Rudy et al., 2022). The chart shows the 31% reduction in mentally unhealthy days and 38% reduction in physically unhealthy days. These programs can make a lasting difference in affecting health outcomes.
Taking Action
Addressing the social determinants of health works and can create profound and lasting change for health outcomes for individuals and communities as a whole. Making changes includes actions from the individual level all the way to the policy level. Individuals can volunteer at programs like Papa, advocate for policies that address the social determinants of health in the local and federal government, and talk to their peers about why this is important. Organizations can start programs similar to Papa and local and federal governments can pass policies that foster positive change.
| Public Health Insight Podcast: Social Determinants of Health |
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Key Takeaways
Social determinants of health are all the social factors that affect health outcomes. These include factors such as environment, finances, access to healthcare, demographics, social support and more. Addressing these issues can help reduce the health disparities that currently exist. Both policies and organizations can work to improve health outcomes by tackling the social determinants of health.
References
Donkin, A., Goldblatt, P., Allen, J., Nathanson, V., & Marmot, M. (2017). Global action on the social determinants of health. BMJ Global Health, 3(Suppl 1), e000603. https://doi.org/10.1136/bmjgh-2017-000603
Golden, S. D., & Earp, J. a. L. (2012). Social ecological approaches to individuals and their contexts. Health Education & Behavior, 39(3), 364–372. https://doi.org/10.1177/1090198111418634
H.R.1319 – 117th Congress (2021-2022): American Rescue Plan Act of 2021. (n.d.). Congress.gov | Library of Congress. https://www.congress.gov/bill/117th-congress/house-bill/1319
Pandemic-Driven Health Policies to address social needs and health equity | Health Affairs Brief. (n.d.). https://www.healthaffairs.org/do/10.1377/hpb20220210.360906/
Rudy, E. T., McNamara, K. C., Goldberg, Z. N., Parker, A., & Nash, D. B. (2022). A call for consistent measurement across the social determinants of health industry landscape. Population Health Management, 25(5), 698–701. https://doi.org/10.1089/pop.2022.0079
Other Related Material
Examples of how SDOH can be Addressed
Written by: Joya Banerjee, MPH, BSN, BA, RN
