Addressing Social Determinants of Health: Strategies for Success

Introduction

Although clinical care has improved in the United States, health inequities still pose a big challenge. Research indicates that while clinical care may influence only up to 20% of the health outcomes at the county level, the social determinants of health can affect up to 50%.

These determinants, like housing, food security, transportation, and socioeconomic factors, have to be understood and acted on for better general health and well-being. This blog discusses effective, evidence-based strategies in addressing SDoH and brings attention to current federal efforts in trying to reduce health disparities.

The Impact of SDoH

According to WHO, the social determinants of health (SDoH) are the conditions in which people are born, grow, live, learn, work, play, worship, and age.

Addressing SDoH requires an understanding of the socioeconomic and environmental considerations affecting patients’ comprehensive approach to health. This includes the assessment of their access to safe housing, nutritious food, reliable transportation, physical environment, education, and social support networks—all of which have huge impacts on health outcomes.

The factors described above are some of the major contributors to the shaping of health outcomes and quality of life.

SDoH plays a critical role in occupational health service. The SDoH can also impact the mental health of workers. For example, workers who experience stress regarding financial insecurity, or who do not have a means of affordable childcare, can increase vulnerability to anxiety or depression, which affects their concentration at work and increases the chances of errors or accidents.  

Comprehensive Strategies of SDoH

The five domains of Social Determinants of Health

A comprehensive strategy of the Social Determinants of Health is broad, but nearly all determinants fall into five distinctive categories.

We present these five major domains by highlighting their impacts and discussing evidence-based strategies to mitigate associated challenges.

1. Economic Stability

Economic stability is fundamental to health and well-being. It includes an individual’s ability to afford basic needs through stable income. Poverty is one of the main social determinants that compounds other health problems, leading to poorer health outcomes and perpetuating cycles of disadvantage. In 2022, approximately 37.9 million Americans were living below the poverty line, often experiencing housing instability and food insecurity.

Key Challenges

• Housing Instability: Families often move frequently between shelters or live in overcrowded conditions that enhance the transmission of disease and other health risks.

• Substandard Housing: Lower incomes often compromise healthy housing by leading to homes with issues such as mold, lack of good heating/cooling, and pests—all of which compromise health and safety.

• Food Insecurity: Economic hardship pushes many to prioritize cost-effective, high-calorie foods over healthier choices, leading to nutritional deficiencies and chronic health issues.

Strategies

• Employment Support: Jobs and job skills programs can enhance economic stability.

• Affordable Housing Initiatives: Policies and programs that increase access to safe, affordable housing can reduce housing instability.

• Food Assistance Programs: Programs like food banks and nutritional education can help alleviate food insecurity and promote healthier eating.

2. Education Access and Quality

Education is one of the strong determinants that greatly impacts health and socioeconomic outcomes in the long term. Quality education offers relevant skills and knowledge that enables them to have better opportunities for higher income and health. However, the gaps in educational access mostly relate to socioeconomic status and location.

Key Challenges

• Dropout Rates of High School: Inadequate funding and absence of support cause kids to drop out of schools, which eventually decreases their opportunities for their future careers.

• Insufficient Career Opportunities: Weak education restricts awareness concerning the availability of opportunities, lifetime earning potential, and future health outcomes.

Strategies

• Increased Funding for Schools: Increased funding for underfunded schools helps improve the achievement of education and decreases the rate of students dropping out.

• Career Guidance and Support: Career guidance and support services may enable students to be oriented toward their educational and professional careers.

3. Healthcare Access and Quality

A properly accessed system of healthcare is essential to detect and treat illnesses and health conditions and ensure the health of individuals, in general. Barriers include insufficient insurance, provider shortages, and geographic disparities—all of which can impede healthcare access in rural areas.

Key Challenges

• Uninsured Populations: One of the most significant groups of uninsured citizens is those of working age, with many unable to obtain a timely diagnosis or treatment.

• Rural Healthcare Disparities: There is a shortage of healthcare providers, making access to both primary and specialized care scarce in rural areas of the country.

Strategies

• Insurance Expansion: Policies aimed at expanding health insurance coverage will help to increase access to necessary medical care.

• Incentives for Rural Healthcare Providers: Programs to encourage healthcare providers to serve rural communities can be initiated to help alleviate provider shortages.  

4. Neighborhood and Physical Environment

The quality of neighborhood and physical environment impacts on health. Opportunities for healthy food, safe housing, and clean environments are key to well-being.

Key Challenges

• Food Deserts: Too many communities do not have access to fresh, healthy food. They resort to processed food with higher rates of diet-related diseases.

• Environmental Health: Contaminated water and air pollution are health risks.

Strategies

• Community Planning and Development: Activities that assure supermarkets and playgrounds help improve neighborhood environments.

• Environmental Protection Policies: Stronger regulation on pollution and assurance of clean air and water can improve the health of the public.

5. Social and Community Context

Social and community contexts: Social and community contexts refer to the social relations and networks with which each person involves themselves. These include the relationships of an individual with family, friends, and the larger social network. Good social support and community involvement are linked with better mental and physical health.

Key Challenges

• Social Isolation: Social isolation can lead to a decline in mental health and decrease the overall level of well-being.

• Negative Social Influences: Bad peer influence or community behaviors, like smoking or drinking, can negatively impact health.

Strategies

• Community Support Programs: Initiatives that build social ties and community engagement can improve mental health and resiliency.

• Health Education and Promotion: Programs that help communities learn about healthy behaviors can counterbalance negative social influences.  

Addressing Social Determinants of Health in Medical Practice

Building trust with patients is really key to implementing the SDoH into a care model. Ensuring that SDoH is embedded into medical practice for comprehensive care delivery and improved patient outcomes is of prime importance. Here, we outline strategies on how one can practically address SDoH in clinical practice, highlighting various factors that address the impact of Social Determinants of Health, which provides a very structured framework that not only bridges the gap between limited time and comprehensive care but also brings a multitude of benefits for society and the individual involved.

Building Patient Trust and Open Communication

Creating a setting where patients will talk freely about lifestyle, environment, and emotional well-being is basic. Building trust will help to get closer, and to develop the ways in which SDoH may be affecting their health. Here are some approaches for open communication.

1. Open-Ended Questions: The first thing to do is ask questions like “What kinds of food do you eat?” for understanding their diet and way of life; then “Where do you obtain your food?” could get at more specifics about their access to nutritious food.

2. Patient Awareness: Some patients may be aware of the barriers; some others may need some guidance. Use these conversations to educate patients about how factors like housing, food security, and transportation can influence their health.

Challenges in Addressing SDoH

Addressing SDoH within the framework of a typical medical practice can be difficult. SDoH can be challenging due to the factors of time and resources. Physicians often don’t know how to integrate these conversations into the patient’s overall short visit. However, the incorporation of SDoH is crucial for the holistic management of health.

Elements that Support SDoH Incorporation

1. Assessments and Screenings: Comprehensive screening programs help to identify the SDoH struggles, such as housing instability, food insecurity, and transportation challenges. These assessments provide an overview that enables us to target patients who experience specific SDoH.
2. Personalized Care Plans: Based on the screening, individualized care plans can be developed to deal with both the medical and social needs of the patient. These plans navigate patients to overall well-being by considering economic and social factors that influence their health.
3. Community Connections: Through community connection programs, care teams help patients seek connection to community resources and support services that address SDoH. This can include linking them to social workers, housing assistance programs, food banks, and transportation services.
4. Patient Education and Support: These programs educate patients on the management of their chronic conditions and promote engagement in their care journey. Periodic follow-ups are part of these programs that allow for the continuous discussion of SDoH-related issues.
5. Medication Management: SDoH factors can affect the patient’s medication adherence. If a patient has financial challenges, through these kinds of programs, providers can collaborate to explore cost-effective medication alternatives that resonate with their care plan and budget.

Conclusion

This serves as a basis to address the social determinants of health for the promotion of health equity and improvement of general health. Housing, nutrition, transportation, and socioeconomic mobility are among the factors that are backed by strong evidence for effective intervention and play a very important role in reducing health disparities.