Social Determinants of Health Framework: How to Address Health Inequities

“Health is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” – World Health Organization

This quote from the World Health Organization highlights the importance of social determinants in health. In the United States, we spend a lot on healthcare but still see health disparities. These disparities often stem from social and economic factors outside of healthcare.

To improve health for all Americans, we must understand the social, economic, and environmental factors that affect health. By tackling these social determinants of health, we can create a fairer healthcare system. This system will meet the needs of all communities.

Key Takeaways

Health is influenced by a complex interplay of social, economic, and environmental factors beyond medical care.
Addressing health inequities requires a comprehensive, multi-sectoral approach that targets the underlying social determinants of health.
Nurses play a crucial role in advocating for and implementing strategies to address social determinants and promote health equity.
Collaboration between healthcare, public health, and community stakeholders is essential for developing and implementing effective health equity initiatives.
Employing a combination of upstream, midstream, and downstream strategies can address health inequities at multiple levels.

Understanding the Social Determinants of Health (SDOH)

The social determinants of health (SDOH) are nonmedical factors that affect health. They include education, employment, housing, income, and more. Knowing about SDOH is key because they impact the economy, national security, and future generations.

What are Social Determinants of Health?

SDOH cover many social, economic, and environmental factors. These factors lead to health inequities. They include social risk factors and structural determinants that affect intermediary determinants. These, in turn, influence health behaviors and outcomes.

Factors Contributing to SDOH Inequities

Poverty and income inequality
Inadequate education and employment opportunities
Substandard housing and unsafe neighborhoods
Limited access to healthcare and transportation
Systemic racism and discrimination

It’s vital to tackle these underlying factors to reduce health disparities. By addressing the root causes, we can improve health and well-being across the population.

“Inequities in health conditions are often tied to the root causes of poverty and racism, emphasizing the need to address these social and environmental factors to reduce disparities and improve health outcomes.”

The Impact of SDOH on Health Outcomes

Social determinants of health (SDOH) greatly affect health outcomes, causing big health disparities in the U.S. People with lower incomes, racial and ethnic minorities, and those living in rural areas face more health problems. They also tend to live shorter lives than those with higher incomes, who are White, and live in cities.

Health Disparities Linked to Social and Economic Factors

The reasons for these health disparities are complex. They stem from social factors and economic factors that affect some groups more than others. Poverty, poor education, and bad housing or transportation can harm someone’s health a lot.

The CDC says SDOH have a bigger impact on health than genetics or healthcare access. Fixing these issues is key to making health more equal and reducing sickness and death rates in different communities.

“Poverty is highly correlated with poorer health outcomes and higher risk of premature death.”

The CDC’s Racial and Ethnic Approaches to Community Health (REACH) has worked since 1999. It aims to lower chronic disease rates in specific racial and ethnic groups in cities, rural areas, and tribes. Health departments can help by showing where community needs and assets are and supporting groups and getting people involved.

In the end, it’s important to tackle the social and economic factors that affect health. This is key to achieving health equity. It ensures everyone can reach their health potential, no matter their social status or situation.

Conceptual Frameworks for SDOH

To understand and tackle the social determinants of health (SDOH), experts have created frameworks. These frameworks help us see how society affects our health. The World Health Organization (WHO)’s Commission on Social Determinants of Health framework is well-known.

WHO’s Commission on Social Determinants of Health Framework

The WHO’s Commission on the Social Determinants of Health worked from 2005 to 2008. They made a detailed framework to explain health inequities. It breaks down SDOH into two main parts:

Structural determinants, like economic and political settings, social class, gender, and ethnicity. These factors create social hierarchies and inequalities.
Intermediary determinants, such as living conditions, mental and social factors, and how we behave and our biology. These are shaped by the structural determinants and affect our health.

This framework helps find where to make policy changes to tackle health inequities. It shows that to really make a difference, we need to tackle big issues like power differences between groups.

“The framework developed by the World Health Organization’s Commission on the Social Determinants of Health (CSDH) was in use from 2005 to 2008 and remains a widely recognized conceptual model for understanding the complex relationships between social factors and health outcomes.”

The WHO’s framework gives a full picture of the social determinants of health. It’s a key tool for researchers, policymakers, and health professionals. They use it to fight health inequities and work towards better health for everyone.

SDOH and the COVID-19 Pandemic

The COVID-19 pandemic has shown us the deep health inequities in our communities. Social determinants of health (SDOH) have greatly affected the pandemic’s impact. Low-income communities and communities of color have suffered the most.

Data shows a grim reality: People of color make up 60% of warehouse and delivery workers and 74% of cleaning service workers in the US. This puts them at higher risk. In the UK, the death rate from COVID-19 is twice as high in black communities compared to white communities. Worldwide, marginalized groups have been hit hard, from the 971 deaths among migrant workers and their families in India to the nearly 40% of employed women worldwide who work in heavily impacted sectors, leading to job and income losses.

These disparities come from long-standing systemic inequities in economic stability, education, and neighborhood environment. The COVID-19 pandemic has made these issues worse. To tackle the pandemic, we must focus on SDOH.

We need a community-driven approach to address health inequities. By investing in strategies that improve social, economic, and environmental conditions, we can create stronger, fairer communities. This is crucial for the future, not just during crises.

Economic Stability and Health

Poverty and income inequality are closely tied to poor health. This includes higher rates of morbidity and mortality. Systemic racism has led to unequal access to resources like housing and education. This puts some communities at higher risk for poor health.

Poverty, Income Inequality, and Health Consequences

People living in poverty face big challenges to economic stability. This can severely harm their health and well-being. Studies show that those with lower incomes have more chronic diseases and shorter lives.

Income inequality also plays a big role in health disparities. Areas with more income inequality have worse health outcomes. This is because of less access to quality healthcare and education.

“Healthy People 2030’s 5 overarching goals all relate to achieving health equity, envisioning ‘a society in which all people can achieve their full potential for health and well-being across the lifespan.'”

To solve these problems, we need a broad approach. Policymakers and leaders must work to make systems fairer. They should aim to improve health for everyone, no matter their income.

Education, Employment, and Health

Education and employment are key to health. How much you learn and your job can really affect your health. Working on these areas is vital for health equity and better health.

Learning more is linked to better health. People with more education tend to have fewer chronic diseases and live longer. Education helps them make smart health choices and get the care they need.

Having a good job is also crucial for health. Jobs that pay well and have good conditions help people feel secure and happy. On the other hand, jobs that are unstable or bad can make people stressed and unhealthy.

To fix these issues, we need to work on education and jobs. We should offer more learning chances, better job training, and fair work practices. By doing this, we can help everyone be healthier and happier.

Indicator	Correlation with Health
Educational Attainment	Higher levels of education are associated with lower rates of chronic diseases, better overall health, and increased life expectancy.
Employment Status	Stable, well-paying jobs with good working conditions can provide individuals with the financial security, access to healthcare, and sense of purpose that contribute to improved physical and mental health.
Job Quality	Poor working environments can lead to increased stress, anxiety, and negative health outcomes.

“Investing in education and employment opportunities is a powerful way to address health inequities and promote well-being in our communities.”

Neighborhood and Built Environment Factors

The place where people live greatly affects their health. Things like housing, transportation, and the physical environment play big roles. They can cause health gaps and unfairness in communities.

Housing, Transportation, and Physical Environment Influence

Bad housing, transportation, and physical settings can harm health. For instance, research shows that some groups face higher risks from drinking water with too much nitrate. This can hurt their health, especially for those who are already vulnerable.

Also, studies find that the built environment affects how active people are and their risk of obesity. Places with few healthy food spots and places to be active can lead to chronic diseases.

Social Determinant	Impact on Health Outcomes
Housing	Inadequate or unstable housing can lead to increased stress, exposure to environmental hazards, and limited access to healthcare resources.
Transportation	Lack of reliable and affordable transportation options can hinder an individual’s ability to access essential healthcare services, employment, and healthy food sources.
Physical Environment	Poor air quality, limited green spaces, and unsafe neighborhoods can contribute to respiratory issues, physical inactivity, and mental health problems.

It’s key to tackle these neighborhood and built environment issues. Doing so can help achieve health equity and better health outcomes for everyone.

social determinants, health equity, community engagement

To tackle the social determinants of health and push for health equity, we need a big, community-focused plan. This plan should involve many groups. It’s about working with community groups, being culturally aware, and letting people help shape health plans.

Knowing what each community needs and can do helps us make better health programs. Community engagement is key to getting real feedback, building trust, and making sure health plans match what the community wants.

Do deep community assessments to learn about the community’s good points, challenges, and resources.
Get people with lived experiences involved in making and running programs. Their views are vital for fairness in health.
Use teamwork in making and carrying out programs to make sure they really meet the community’s needs.
Use fair ways to engage people, like finding hard-to-reach folks, creating safe places for talks, paying participants, and sharing power.

By focusing on the community in tackling the social determinants of health, we can build fairer, more welcoming places. Places where everyone can be well.

“When you have a community-driven process, you get so much more buy-in and ownership from the community. They feel like they have a voice and a say in what’s happening.”

Remember, health equity is more than just better health for people. It’s about fixing big problems that stop some groups from doing well. By teaming up with the community, we can create real, effective solutions.

Nursing’s Role in Addressing SDOH

Nurses are key in tackling social determinants of health (SDOH). They work to include social needs in care models. By teaming up with social workers, nurses help address complex social issues. This approach improves population health and promotes health equity.

Integrating Social Needs into Care Models

Nurses are great at spotting social needs because they spend a lot of time with patients. Health centers often check for these needs. It’s important to have policies that support nurses in this role.

Screening for social needs and referring patients to services is becoming more common. However, there are challenges like patients being hesitant to share and the need for better technology.

Nurses can make a big difference by addressing social needs in clinics. They can also push for policy changes and work with other professionals. This is vital because social factors like education and income affect up to 75% of health outcomes.

“Health equity can be achieved by addressing SDOH at the population level and social needs at the individual level. Improving health equity benefits everyone through economic growth, a healthier environment, and national security.”

The COVID-19 pandemic has shown us the health and social inequities in our communities. Deloitte says these inequities cost about $320 billion a year. If not fixed, this could reach $1 trillion by 2040. Nurses are crucial in addressing these issues and improving health for everyone.

Upstream, Midstream, and Downstream Strategies

Improving health and fairness in health care needs a wide approach. Upstream strategies tackle the big reasons for health gaps, like laws and social policies. Midstream efforts aim at community resources and how people act. Downstream actions give direct help to people and families.

Upstream work tries to change big systems that hurt health. It includes pushing for fair wages, affordable homes, and better mental health care. These changes can deeply improve health by fixing the main problems.

Midstream actions focus on things like food access and safe places to walk. They help make communities better for health. This lets people and groups make better choices for their health.

Downstream efforts give direct help, like finding food and health services. But, they might not fix the big health problems. Working together is key to really help health and fairness.

Health experts should question why health problems happen and work with others. They need to tackle the big issues and learn new skills. By using all three strategies, we can tackle the many factors that affect health and fairness.

Upstream Strategies	Midstream Strategies	Downstream Strategies
Advocating for living wage policies Promoting affordable housing policies Expanding mental health programs	Improving food security Enhancing transportation options Promoting physical activity in neighborhoods	Screening for social needs Connecting individuals to relevant resources Providing direct health and social services

There’s not much research on how working together affects health fairness. But, the studies we have show some positive effects. Working together helps everyone see how they can help health and fairness.

Public health’s primary role is seen as leadership and advocacy for equitable population health.

Cross-Sector Collaboration and Policy Interventions

Improving health and equity needs teamwork and the right policies. Health equity efforts require partnerships with many groups. This includes community groups, healthcare, and policymakers.

Together, they can tackle the main reasons for health gaps.

Building Partnerships for Health Equity Initiatives

Rural areas are coming together to fight health gaps. They’re working with groups from different fields. This includes education, economy, and more.

For example, the Marshall Browning Hospital and Pinckneyville Hospital teamed up for mental health. Adventist Health Clear Lake’s Project Restoration helped those without homes. And the Williamson Health and Wellness Center’s Healthy in the Hills Network worked on West Virginia’s health issues.

These community partnerships show the value of diverse voices. They keep everyone involved and aim for lasting change. The Georgia Health Initiative’s Two Georgias Initiative and Rhode Island’s Health Equity Zone initiative are great examples.

Through cross-sector collaboration and smart policy interventions, we can tackle health gaps. This improves health and well-being for everyone.

Conclusion

Improving health equity is key to better population health and less health disparities. We need a community-focused approach. This involves many stakeholders and addresses social needs in care.

Nurses and healthcare workers are crucial in making healthcare fairer. They help tackle health inequities by working with others across sectors. This way, we can build a more just healthcare system.

Progress has been made, with 19 states now helping Medicaid with social needs screening. Almost all plans are working on social determinants of health. The Center for Medicare and Medicaid Innovation also supports this effort.

Yet, there’s still much to do. Health gaps due to social and economic factors are still big. We need to keep working to involve communities and improve policies.

By joining forces, we can make a healthier, fairer future for everyone. Together, we can overcome health inequities and create a better world.

FAQ

What are Social Determinants of Health (SDOH)?

SDOH are nonmedical factors that affect health. They include where and how people live, work, and age. Examples are education, employment, and housing conditions.

How do SDOH contribute to health inequities?

SDOH impact the economy and national security. They lead to differences in health outcomes. These differences are due to policies and structures.

What are the impacts of SDOH on health outcomes?

Low-income and minority groups face more health issues. They have lower life expectancy than others. These disparities stem from social and economic factors.

How has the COVID-19 pandemic affected SDOH and health inequities?

The pandemic worsened health inequities in low-income and minority areas. It highlighted long-standing health disparities caused by social and economic factors.

How do economic factors, such as poverty and income inequality, impact health?

Poverty is linked to poor health and early death. Racism has created health inequities in communities of color. These inequities affect access to housing, education, and employment.

What is the relationship between education, employment, and health?

Education and job conditions impact health. Improving these areas is key to health equity and better health outcomes.

How do neighborhood and built environment factors influence health?

The environment affects health. Factors like housing and food access play a big role. Poor environments lead to health inequities.

What is the role of community engagement in addressing SDOH and promoting health equity?

Community engagement is crucial for addressing SDOH. It involves partnerships and empowering residents. This approach promotes health equity.

How do nurses contribute to addressing SDOH and achieving health equity?

Nurses focus on social needs in care. They work with social workers to address complex needs. Their models improve health and equity.

What are the different strategies for addressing SDOH and promoting health equity?

Addressing SDOH requires a multi-level approach. Upstream strategies tackle policy causes. Midstream targets community resources. Downstream focuses on direct services.

What is the importance of cross-sector collaboration and policy interventions in addressing SDOH?

Collaboration and policy changes are vital. They help address SDOH and promote equity. Partnerships with various stakeholders are essential for success.