The social determinants of health (SDOH) are a group of factors that work together to influence your overall health and wellbeing. They are environmental rather than innate and may be outside of your control. The SDOH fall into five domains that, collectively, encompass everything about your life, from birth and aging to learning, work, and play. Plus, they play a crucial role in determining your healthcare access and preventive health journey.
1. Economic factors
A shocking 10% of Americans live below the poverty line. An inability to pay for such basic necessities as housing and food can result in poorer health. Some people have trouble maintaining a steady job, especially if they are also living with disabilities or other challenges. Yet, having a job does not guarantee economic security. According to a 2023 report by the Bureau of Labor Statistics, about 6.4 million Americans are considered “working poor” — that is, they live below the poverty line despite regular employment.
2. Education
Higher levels of educational attainment are correlated with longer and healthier lives. But children from low-income families, those subjected to bullying, and kids with disabilities are less likely to graduate from high school or go to college. In addition, some schools perform poorly for a variety of reasons, and kids in those schools face an uphill battle for educational achievement.
3. Built environment
Your built environment includes all the areas where you spend significant time, from your home to your worksite to the places where your kids play. Many neighborhoods have major health hazards, such as unsafe water or high rates of violence. You may also be exposed to dangerous conditions at work, such as chemicals or working at heights. Those who spend time in unsafe built environments are at greater risk for health problems throughout their lives.
4. Community
This encompasses all the relationships, both positive and negative, that you have with the people around you. Strong bonds with family, friends, coworkers, and neighbors can boost health. But if you are estranged from your family, constantly fighting with the woman next door, and having trouble bonding with people at work, your health could be at risk.
5. Healthcare
Good healthcare includes regular routine screenings and early interventions for any problems that arise. But 1 in 10 Americans lack basic health insurance. Others have to commute a long way to see a primary care doctor. Without access to high quality healthcare, people are at much higher risk for poor health outcomes.
Compounding Effects
Of course, each social determinant of health doesn’t exist in a vacuum. Instead, they all work together to heighten each other’s effects. For example, a child living in a rough neighborhood may face violence, unsafe air and water, and other negative impacts from his built environment. That same child likely also attends the neighborhood school, which probably struggles to attract high-quality educators and might be short of funding. Meanwhile, his family may face chronic unemployment and food insecurity. In this scenario, a child might be forced to drop out of school early to take a job.
Older adults also face particular risks from compounding SDOH effects. One of the most important factors in healthy aging is remaining a vibrant and active member of your local community. But this can be difficult for older adults coping with negative social determinants of health.
- Low-income older adults are more likely to develop a disability or chronic illness
- Lack of social support is correlated with a higher risk of conditions such as dementia
- Poorer neighborhoods tend to have worse roads, less public transit, and fewer accessibility options for older adults attempting to age in place
- Rural areas with few healthcare options, difficulty navigating medical forms and charts, and high out of pocket costs can make it tough for seniors to access quality healthcare
Healthcare access can help people overcome challenges
All of the social determinants of health can play a vital role in helping people live longer, healthier lives. But access to high quality healthcare can help to overcome many of the inequities associated with the other SDOH. Healthcare providers play five key roles:
- Becoming aware. Many providers now ask patients to fill out a social risks screener. This helps them to understand the challenges you might face so that they can frame your care accordingly.
- Making adjustments. Clinics might open early or stay open late to accommodate patients’ work schedules. They may adjust patient loads or offer telehealth services to better care for those with complex SDOH needs.
- Providing assistance. A lot of healthcare professionals are aware of the available resources in the communities they serve. Your provider might refer you to a social worker, offer advice on building stronger relationships, or provide other forms of assistance to help you cope with your SDOH challenges.
- Alignment. Many healthcare workers, especially those who serve marginalized communities, work hard to align their practices with those of local social service organizations. They may form alliances and work together to treat patients holistically rather than one symptom at a time.
- Advocacy. Healthcare organizations have a lot of social, political, and economic capital in the communities they serve. This means that they are well positioned to call for meaningful change. This might include calls for improved public transit, working with city leaders to reduce community violence, or many other practical actions.
Your EHE benefits include far more than an annual physical exam, and we work hard to provide you with comprehensive year-round care based on your individual needs. If you’re ready to take your health to the next level, while overcoming any SDOH challenges you face, you can schedule your annual exam at my.ehe.health.