The social determinants of health (SDoH) are factors that influence an individual’s health such as the conditions in the places and environments in which people are born, live, learn, work, play and age that ultimately affect people’s health and quality-of-life outcomes and risks.
What are the SDoH?
The SDoH include a diverse array of factors, for example, safe housing, employment status and job opportunities, access to physical activity opportunities, air and water pollution, literacy skills, and discrimination and violence. Various models exist that help to explain and group the SDoH. One of the most common models used to explore the SDoH is Dahlgren and Whitehead’s 1991 model which maps out SDoH at various levels, showing the relationship between one’s health and individual characteristics (both relating to lifestyle and biology); social and community factors; living and working conditions; and wider socio-economic, cultural and environmental conditions. The US Department of Health and Human Sciences groups the SDoH into 5 domains: economic stability, education access and quality, health care access and quality, neighbourhood and built environment, and social and community context.
What is the evidence for using the SDoH?
It is difficult and often misleading to estimate how much of an influence the social determinants of health have, both in relation to each other and in relation to other determinants such as medical care or genetics. Nonetheless, various estimates exist which in general agree that the majority of health determinants are related to the SDoH, as opposed to medical care and biology.
The SDoH provide us with a framework for understanding the broad factors that affect our health, outside of the clinical setting and beyond our biology and genetics, that might be the root cause of health disparities and inequities. For example, if people do not have access to healthy foods (perhaps due to shops not stocking healthy foods, or healthy foods being more expensive than unhealthy foods), they are less likely to have good nutrition, which increases their risk of certain health conditions, such as diabetes and heart disease. Trying to encourage healthy choices is unlikely to eliminate these disparities, but addressing the barriers to healthy food access (the SDoH) could have more success.
How to address the SDoH?
Since the SDoH covers a wide range of health determinants, addressing the SDoH also requires a wide range of activities and policies. A Health in All Policies (HIAP) approach is vital in addressing the SDoH since the health system is often not best placed to address some determinants. For example, health actors can work with the education sector to impact education-related determinants, with the environment sector to address air pollution, or the housing sector to improve the safety of living conditions