Social determinants of health (SDOH) refer to a diverse set of social, economic, environmental, and systemic factors that shape health outcomes across communities. SDOH can encompass circumstances related to housing, transportation, income, food access, neighborhood conditions, education, employment opportunities, social connections, access to healthcare, and much more.
An extensive body of research demonstrates that Social Determinants of Health (SDOH) profoundly influence an individual’s health and well-being over their lifetime, from conception to older adulthood.
As the healthcare landscape continues evolving towards value-based care, health and wellness services, particularly those offered by Complete Wellness as the right healthcare service provider, have a vital role to play in addressing SDOH. These services emphasize comprehensive, proactive, and integrative approaches, focusing on holistic health management and personalized care strategies.
This article will provide an in-depth examination of key SDOH domains, discuss evidence-based strategies for health and wellness services to address SDOH, highlight collaborative approaches across sectors, analyze challenges and barriers in this work, and explore future directions for the field. The objective is to underscore the need for multidisciplinary efforts to mitigate adverse social and environmental conditions and improve population health equitably.
Understanding Core Domains of Social Determinants of Health
SDOH are frequently conceptualized across five broad domains:
- Economic Stability: Employment status, income level, housing costs, access to healthy foods, transportation barriers, and ability to cover medical expenses all profoundly affect health behaviors, stress levels, and outcomes. The inability to consistently afford basic needs leads to increased risks of chronic illnesses, infections, mental health issues, and reduced life expectancy.
- Education Access and Quality: Health literacy, language/literacy proficiency, early childhood education, vocational training, and educational attainment strongly predict overall health status. Limited education restricts access to health-promoting resources and creates barriers to navigating complex systems.
- Healthcare Access and Quality: Having adequate health insurance coverage and access to culturally competent primary and preventive care helps facilitate timely diagnosis, treatment, and ongoing disease management. Lack of a consistent healthcare provider is linked to poorer self-reported health.
- Physical Neighborhood and Environment: The physical conditions where people live, work, play, and gather shape opportunities for healthy behaviors. Safe green spaces, air/water quality, housing conditions, access to nutritious foods, and neighborhood violence levels influence well-being.
- Social and Community Context: Meaningful social connections, civic participation, and cultural identity provide a sense of belonging and purpose. Social isolation, discrimination, stigma, and incarceration history are detrimental to both mental and physical health.
These SDOH domains are highly interrelated and cumulative over time. For instance, families living in poverty often reside in unsafe neighborhoods with environmental hazards, food deserts, struggling schools, inadequate transportation, discrimination, and substandard housing – each of these circumstances compounding the detrimental health effects of the others due to the clustering and convergence of risk factors.
Strategies for Health and Wellness Services to Address SDOH
Health systems, clinics, wellness centers, and community health agencies can employ multifaceted strategies to address SDOH, including:
- Offering job skills training, resume workshops, interview preparation, and collaborating with workforce development agencies to connect patients to employment opportunities.
- Screening for food/housing insecurity and assisting with public benefits enrollment.
- Establishing medical-legal partnerships to assist with employment law, debt/mortgage issues, and IRS controversies that affect health.
- Providing health literacy and ESL classes.
- Partnering with schools, libraries, and adult education centers to offer nutrition education, chronic disease self-management, parenting classes, and other training relevant to community needs.
Employing community health workers and patient navigators to assist underserved patients in obtaining health insurance coverage, finding a consistent primary care provider, and providing social support during healthcare visits.
- Launching mobile fruit/vegetable markets and onsite food pharmacies to increase access to healthy, affordable foods in places lacking full-service grocery stores.
- Advocating for safe, affordable housing policies and incentives for grocery stores, farmers markets, and recreational facilities in low-access neighborhoods.
Social and Community Context
- Deploying interventions to reduce social isolation such as friendly caller programs, community gardening initiatives, support groups, and classes to increase social connectedness.
- Providing trauma-informed care training for all staff and implementing policies to prevent discrimination in healthcare settings.
Collaborative Approaches to Address SDOH
Effectively addressing complex social and economic factors requires collaborating across sectors through:
- Developing partnerships with public health departments, transportation agencies, housing authorities, community action programs, faith-based organizations, schools, libraries, community centers, food banks, and other stakeholders.
- Building interdisciplinary teams with primary care providers, nurses, social workers, community health workers, health educators, dietitians, pharmacists, and mental health professionals all working together to address SDOH domains.
- Investing in health information technology tools, screening questionnaires, electronic health record enhancements, and community health needs assessments to systematically identify SDOH needs and track outcomes.
- Using community-based participatory research methods to engage patients, caregivers, and local leaders in assessment, planning, implementation, and evaluation.
Overcoming Barriers to Addressing SDOH
Persistent challenges include sustainable funding and reimbursement for SDOH-related services, overcoming cultural and language barriers, staffing shortages, lack of transportation infrastructure in many communities, determining appropriate outcome measures to evaluate long-term impact, and inconsistent cooperation from potential cross-sector partners. Policy changes, advocacy, consistency, relationship building, and targeted funding opportunities can help overcome these barriers.
In summary, addressing SDH requires health and wellness services to look beyond the walls of their organizations and work collaboratively across sectors to improve economic stability, increase educational attainment, enhance social connectedness, ensure access to nutritious foods and livable wages, dismantle structural racism, and provide high-quality medical care to all community members. While this work is challenging, it is essential for impacting health equitably across neighborhoods, racial/ethnic groups, and socioeconomic status.
Health systems have an unprecedented opportunity to demonstrate leadership in piloting and evaluating innovative models focused on prevention and total well-being by authentically partnering with the communities they aim to serve.