8.3: Social Determinants of Health (SDOH)
According to Healthy People 2030, the social determinants of health (SDOH) are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” ( Social Determinants of Health - Healthy People 2030 , n.d.). These social determinants of health can be grouped into 5 major categories: economic stability, educational access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (see Figure 8.1 below). It is important to remember that these categories are interrelated; each one has effects on the others.
Inequities exist in each of these categories, which can have significant effects on health outcomes - both immediately and later in life. Recognizing these social determinants of health is imperative for successful public health programs. Understanding the SDOH can help public health practitioners discover influences of health behaviors, barriers and motivators to change within a community, and help them design truly effective health promotion programs and advocate for health policies that improve health equity.
Let’s take a look at an example of a health behavior and health outcome that could be addressed by community health interventions: cigarette smoking and its link to lung cancer. If the health intervention only focuses on the behavior of smoking, there may be other factors that influence a person’s likelihood to pick up smoking that get ignored; including economic, education, policy, and environmental influences. Poorer communities are more likely to have higher rates of cigarette smoking (Hiscock et al., 2011). Those with lower levels of educational attainment tend to earn lower wages, increasing their chronic stress levels, which may also lead to the adoption of health-risk behaviors, all while having less access to smoking-cessation support. If smoking is also permitted in stores, restaurants, and public places, other people will be exposed to second-hand smoke and young people will see cigarette smoking behavior modeled for them. Let’s say a public health practitioner identified high smoking rates in this example community and immediately proposed an anti-smoking advertisement campaign utilizing shock tactics (like billboards with images of tar-covered lungs). Not only might the campaign not be successful at decreasing cigarette smoking, ultimately it may even cause more resistance to public health advice within that community, as individuals perceive these billboards as “preachy” or attempting to constrict personal freedoms. Although the public health project may have sound medical rationale, it didn’t take into account these other factors that influence behavior just as much as personal choice. See Figs. \(\PageIndex{2}\) and \(\PageIndex{3}\) below for current smoking rates reported by U.S. adults in 2021, by both education level and household income.
In the sections that follow, we’ll dig deeper into each of the 5 social determinants of health to learn more about inequities within each category, and how these disparities impact health outcomes for individuals and communities.