Social Determinants of Health (SDOH)

Image courtesy of HealthyPeople.Gov

Background on SDOH

The CDC defines Social Determinants of Health (SDOH) as the “conditions in the places where people live, learn, work, and play”. The reason these SDOH matter is because they can create or mitigate barriers to care. Let’s break that out a bit further, the conditions where patients:

Live: Does patient have access to clean air, temperature control, healthy eating? Are they in a stable housing environment? Are they considered below the poverty line?

Learn: Does patient have access to educate on their conditions at their learning levels? Do they have a way to learn about community programs that could support them?

Work: Does patient have a “safe” work environment that is conducive to their treatment plan? Is patient given appropriate personal protective equipment? Etc.

Play: Is the patient active? Do they have the means to be active in their community? Are there barriers to being active, such as unsafe external environment or mobility issues?

With just the few questions listed above a larger picture begins to emerge. The fact is SDOH matter in the holistic view of the patient. It may be that a non-compliant patient, isn’t non-compliant by choice. There may be factors prohibiting their compliance, also known as ‘barriers to care’.

There are five key areas of social determinants of health (SDOH):

  1. Economic Stability
  2. Education
  3. Social and Community Context
  4. Health and Health Care
  5. Neighborhood and Built Environment


HealthyPeople.Gov has been working to create awareness and support for those interested in beginning their own SDOH programs because the facts are astonishing 3:

  • Infant mortality: Infant mortality increases as mother’s level of education decreases. In 2004, the mortality rate for infants of mothers with less than 12 years of education was 1.5 times higher than for infants of mothers with 13 or more years of education.
  • Tooth Decay: Between 2001 and 2004, more than twice as many children (2–5 years) from poor families experienced a greater number of untreated dental caries than children from non-poor families. Of those children living below 100% of poverty level
  • Access to Care: In 2006, adults with less than a high school degree were 50% less likely to have visited a doctor in the past 12 months compared to those with at least a bachelor’s degree.
  • Income: Low socioeconomic status (SES) is associated with an increased risk for many diseases, including cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer as well as for frequent mental distress.

Clinics and facilities of every size can support patient outcome improvement by implementing measures that review and accommodate for patient’s social determinants of health. Whether you’re ready to implement a robust community involved program, or you’re only ready to start a brief patient questionnaire, every step counts.  As you can see above the facts are clear, patients with SDOH-based barriers need more support.

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