What Are Social Determinants of Health (SDOH)?
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Medically reviewed by Soma Mandal, MD
Your surrounding environment plays a significant role in your overall health and well-being. The neighborhood you grew up in or how close you live to a medical facility are some examples of factors that can determine your likelihood of developing certain health conditions and your access to care in receiving treatment for these conditions. These socioeconomic, political, cultural, and environmental factors are known as social determinants of health (SDOH).
According to the Centers for Disease Control and Prevention (CDC), the social determinants of health are non-medical factors that influence your health outcomes. More specifically, SDOH are the conditions and situations that you are born in, grow in, work in, live in, and age in that shape your daily life.
Because SDOH can vary for different groups of people, it's important to address these determinants. But why? People who come from various socioeconomic or cultural backgrounds often experience differences in their health outcomes. For example, while some people may have easier access to receiving top-notch medical treatments, others may not have any health insurance at all. Addressing these health disparities is one way to get closer to health equity—or, the concept that anyone has the chance to obtain their highest level of health, despite any disadvantages.
The 5 Domains of SDOH
There are five primary types of social determinants, which include 1) economic stability, 2) education access and quality, 3) healthcare access and quality, 4) neighborhood and built environment, and 5) social and community context. These five domains encompass a variety of factors that affect your health outcomes, such as job opportunities, pollution, and discrimination.
Economic Stability
In the U.S., economic stability is an essential way to afford proper medical care and implement healthy lifestyle choices. Having a steady and well-paying job funds basic needs like food, housing, and health insurance. But, your income can also help you pay for health emergencies (such as needing surgery).
Unfortunately, for many Americans, it’s not always easy to meet these needs. In fact, 10% of the U.S. population lives in poverty—meaning, they do not have the financial resources to sustain any of their basic needs. And, 25% of families experience difficulties in paying for food and housing. But what contributes to economic instability? Well, several factors play a role, including:
Disabilities: People who live with disabilities and underlying health conditions may have difficulty finding or keeping a job. Lack of employment can leave you uninsured (without health insurance), making it harder to afford proper treatment for your condition.
Housing instability: Not having enough money for adequate housing can cause challenges such as not being able to pay rent or mortgage on time, living in overcrowded situations, or experiencing homelessness. These living conditions can contribute to emotional and financial stress, which is a risk factor for conditions like anxiety, high blood pressure, and heart disease.
Food insecurity: Lack of access to regular nutritious foods can increase your risk of malnutrition, obesity, and type 2 diabetes and lower your life expectancy.
Education Access and Quality
Providing equal access to quality education can allow children and adults to improve their health and well-being. If you can attend a high-quality school and graduate from that school, you’re more likely to obtain a stable job to provide for yourself, which affords you the ability to take care of your health.
However, you may not get the same opportunities for adequate and accessible education as other peers your age. This disparity can eventually play a role in your health outcomes. For example, students who don’t complete high school are more likely to experience poor health and premature death compared to those who receive their diplomas. But, several factors can hinder your or your child’s ability to achieve a good education, which include:
Bullying: Children who come from low-income homes, are BIPOC (Black, Indigenous, or other person of color), or live with a disability, are more likely to experience discrimination and bullying from their school peers. Being bullied can increase your risk of having lower academic performance, developing mental health conditions like depression, and partaking in substance use at higher rates.
Financial barriers to education: While some students may aspire to attend college, not everyone has the financial capabilities to go to a university—even with loans and financial aid. Not having the financial means to go to college can increase your risk of developing coronary artery disease (CAD). Studies also show that people who go to college have a longer lifespan compared to those who don’t receive an education after high school.
Single-parent homes: While not always the case, children in single-parent families may have higher dropout rates and lower academic performance. Researchers suspect that children from single-parent homes may need to get jobs earlier to help support their families which can distract them from their studies and increase the risk of mental health conditions, due to higher stress.
Health Care Access and Quality
Access to quality healthcare is a significant factor in your quality of life. Going to regular check-ups with your healthcare providers and getting preventative care, such as cancer screenings, can help you obtain better long-term health outcomes.
When the Affordable Care Act (ACA) was passed in 2010, more Americans could receive low-cost health insurance. Yet, as of 2022, 43% of working adults were underinsured—meaning that while they had insurance, their insurance provider didn’t give them coverage for affordable healthcare for all of their medical expenses. The following factors can contribute to your access (or lack thereof) to proper healthcare:
Being uninsured: Not having insurance can hinder your access to a primary care provider (PCP). Your PCP can help evaluate your symptoms, order diagnostic tests and screenings, prescribe medications, and give you personalized medical advice. Without insurance and a PCP, your health conditions may go undiagnosed and increase your risk of complications due to lack of access to treatment.
Proximity to care: One of the most common barriers to quality healthcare is living far away from adequate medical facilities. This hurdle is especially prominent among people who live in rural communities. Current research shows that about 60 million Americans live in rural areas and don’t have immediate access to culturally competent medical care if they need it. These factors can contribute to lower attendance rates at doctor’s appointments, longer stays at the hospital due to untreated conditions, and lower survival rates.
Transportation barriers: About 3.6 million people in the United States don’t receive medical care due to transportation difficulties. Having a car or proximity to adequate public transportation can mitigate transportation troubles. Without these structures in place, you may be more likely to miss doctor’s appointments and pay more for healthcare due to transportation costs.
Neighborhood and Built Environment
Where you’re born, live, work, play, and age can determine whether or not you’ll face better or worse health outcomes throughout your life. Your location and how safe you feel in these places can play a large role in your overall health.
Unfortunately, not everyone has access to a healthy and safe neighborhood. BIPOC and low-income communities especially experience racism and structural inequalities that affect where they live and what resources are available in their neighborhoods. But how exactly does your environment affect your health? Here are some examples to consider:
Violence: Living in an area that is prone to community violence (such as crime or shootings) may lead to physical injuries. Exposure to these conditions often affects your emotional well-being and increases your risk of developing depression, anxiety, and post-traumatic stress disorder (PTSD).
Pollution: Living near air pollution sources, such as major roadways, rail yards, and industrial plants, may lead to the development of chronic conditions like asthma, cardiovascular disease, and even premature death.
Secondhand smoke: Even if you don’t smoke, being around someone who smokes can be detrimental to your health. Both brief and long-term exposure to secondhand smoke may increase your risk of coronary artery disease (CAD), stroke, and lung cancer. For people assigned female at birth (AFAB), secondhand smoke may lead to reproductive complications, such as a low birth weight.
Social and Community Context
Having a strong support system of family, friends, co-workers, and your community can greatly improve your health and well-being. A stable support system can offer you emotional support to deal with challenges and tangible assistance (such as making meals when you’re sick). However, without a supportive community, you may experience adverse health effects. These factors, specifically, can affect your health:
Discrimination: Unfortunately, BIPOC often experience some level of racism during their lifetime. Racism can take many forms—whether it’s overtly being called a racial slur, not getting proper funding in schools with students of color, or missing out on a job opportunity because of the color of your skin. But experiencing discrimination also affects your health and can increase your risk of cardiovascular (heart) disease, high blood pressure, certain cancers, pregnancy complications, and mental health conditions.
Incarceration: Racial bias in the U.S. criminal justice system and prisons disproportionately affects BIPOC communities. Research suggests that 1 out of 3 Black men and 1 out of 6 Latino men are incarcerated (in prison). These statistics are drastically different among white people—where 1 out of 17 white men are imprisoned. There is a higher risk of disease while incarcerated too. People in prison are more likely to develop high blood pressure, hepatitis, cancer, and asthma. But these health effects also trickle down to children of incarcerated folks, as having a parent or caretaker in jail causes higher rates of chronic stress, depression, obesity, and social isolation.
Health literacy and language barriers: Health literacy is a term that describes how well someone can understand, find, and use health information and medical resources. About 35% of adults in the U.S. have low health literacy—which often affects groups like immigrants, refugees, non-English speakers, and people who left school early. Limited health literacy coupled with a lack of providers who speak other languages can greatly affect your access to proper treatment. If you don’t have a provider who can understand you, it becomes difficult to explain what symptoms you’re experiencing and advocate for your needs in healthcare settings.
Who Experiences Health Inequities?
The social determinants of health contribute to health inequities—or, the systemic differences in the opportunities that people have in achieving optimal health. These inequities (sometimes called disparities) can worsen health outcomes. It's worth noting that some groups face more inequities. These disparities are often based on differences in:
Race
Ethnic background
Religion
Socioeconomic status
Gender
Age
Sexual orientation
Gender identity and gender expression
Geographic location
Disability status
Citizenship status
Education level
Keep in mind: being part of minority groups of more than one of the above categories can further prohibit your access to proper medical care. In 1989, professor Kimberlé Crenshaw coined a term called "intersectionality"—which basically means how different systems of power and oppression (such as racism, sexism, or classism) intersect (or, work together) to shape your lived experiences, including the status of your health and well-being.
In practice, this means that people from minority groups don't receive the same privilege to access structures in place that promote health—such as quality education, access to healthy foods, higher income levels, and adequate housing in a safe neighborhood.
Instead, groups like BIPOC communities, those that come from low-income neighborhoods, people who have a disability, or LGBTQ+ folks are given limited access to optimal health due to the oppressive structures in place. These inequities can then worsen health outcomes, such as increasing the risk of health conditions, lowering life expectancy, and limiting quality healthcare.
Opportunities for Population Health Equity
Experts know that these disparities exist, but what happens now? Well, many strategies are in place to address SDOH and improve the quality of life for people who structurally don't receive proper access to optimal health and healthcare services.
One of the most prominent approaches to health inequity is Healthy People 2030—which is a government-funded public health initiative to address health disparities and improve the well-being of individuals, groups, and communities in the U.S. This program sets objectives (goals) to meet by 2030. The Healthy People initiative set 359 objectives to meet, which include promoting health literacy, reducing bullying in schools, and improving access to health screenings.
Other programs in place to address health inequities include:
Pathways to Population Health Equity (P2PHE): Offers resources to help professionals (public health specialists and healthcare providers) develop better public health systems
Mobilizing for Action through Planning and Partnerships (MAPP): Provides communities information about health issues in their neighborhoods and delivers resources to act on these issues to make positive changes
Despite these programs, it's important to note that much work is still left to nurture health equity across the board and collectively work together to improve the health of all communities in the U.S.
A Quick Review
The social determinants of health are non-medical factors that influence your health outcomes. The five domains of SDOH include economic stability, education quality, healthcare access, neighborhood, and social and community context. Factors like discrimination, financial barriers, and limited health literacy can all affect your ability to obtain optimal health. While glaring disparities in health and healthcare access exist, programs like Healthy People 2030 are in place to better address these concerns.
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