Social determinants of health (SDOH) are non-medical situations or conditions that affect a person’s health status and well-being. SDOH may include economic stability, education, healthcare access, neighborhood and physical environment, and social and community culture.
Impact on Health Outcomes
SDOH have been elevated in importance as evidence demonstrates that these factors play a crucial role in health outcomes including:
- Access to healthcare: Limited health resources, transportation, and/or insurance can severely limit access to quality healthcare.
- Chronic disease: SDOH are correlated to the development and progression of chronic diseases such as heart disease, diabetes, and obesity.
- Morbidity and premature mortality: Several SDOH are associated with higher rates of morbidity and premature mortality.
A review of the following Social Determinants of Health question from the CMS Health-Related Social Needs Screening Tool can reveal how a questionnaire can raise awareness of issues that many people may deal with every day.
SDOH Questions
Think about the place where you live. Do you have problems with any of the following?
- Pests such as bugs, ants, or mice
- Mold
- Lead paint or pipes
- Lack of heat
- Oven or stove not working
- Smoke detectors missing or not working
- Water leaks
- None of the above
Importance of these questions
The importance of this question’s responses is well documented:
- Pests like bugs, ants, and mice are a health concern because they can carry and spread diseases, contaminate food and surfaces, and trigger allergies and respiratory issues.
- Mold is a health hazard because it can produce allergens, irritants, and in some cases, potentially toxic substances (mycotoxins), which can cause allergic reactions, asthma, respiratory problems, and other health issues.
- Lead-based paint is a significant health concern because lead is a highly toxic metal that can cause serious health problems, especially in children, including damage to the brain and nervous system, learning disabilities, and behavioral problems.
- A lack of heat, or hypothermia, is a serious health concern because it can lead to a dangerous drop in body temperature, causing organ damage, and potentially death.
- A non-working oven can be a health concern because it can lead to the consumption of improperly cooked food, potentially causing foodborne illnesses, and it can also lead to the buildup of dangerous fumes or fire hazards if the oven is gas-powered.
- A non-working smoke detector is a serious health concern because it increases the risk of death or injury in a fire, as it does not provide early warning, allowing fires to grow and spread rapidly, leading to potential smoke inhalation and burns.
- Water leaks are a health concern because they can lead to mold and mildew growth, which releases spores into the air that can cause respiratory issues, allergies, and other health problems, especially for those with pre-existing conditions.
Other impacts
Other Social Determinants of Health questions may assess the following areas or more:
- Education access and quality: Access to a quality education can impact employment opportunities and future economic security.
- Healthcare Access and quality:Public or private transportation to basic healthcare and/or specialty care can limit access to timely screening and/or critical medical interventions; and language barriers can hinder access to community services and healthcare.
- Neighborhood and physical environment:Exposure to potential hazardous materials, community violence, public transportation access, and lack of access to healthy foods and green spaces can negatively affect health.
- Social and Community Context:Social isolation and lack of social support can negatively change mental and physical health.
- Socioeconomic factors: Economic stability can lead to food and housing insecurity; and cultural influence can influence relationships with organizations with goals to support a community. SDOH also include the broader forces and systems that shape everyday life conditions.
Community Benefits of SDOH
- Improvement in overall community health morbidity and mortality. Reducing rates of chronic illness and improved mental health increase life expectancy and improve quality of life.
- Knowledge of recurring SDOH can support better community planning and / or development of community services to address those factors.
- Communities that improve negative SDOH tend to experience a ripple effect of positive outcomes including economic stability indicators, improved safety and security, and a stronger sense of individuals’ control over life outcomes.
Community Disadvantages of SDOH
- SDOH are complex and interrelated. Isolating the cause and effect for a specific recurring SDOH issue is challenging and often requires a coordinated effort to address multiple factors which may not always be appreciated by the community.
- SDOH intervention can demand significant resources and funding. Identifying the source of resources that may be required for years can be challenging.
- While identifying non-medical issues that impact someone’s health and well-being is easy, collecting data and evidence on the success of intervention programs to address SDOH is more challenging. Some impacts may be immediately measurable, while others may take years to see the full effect.
- The likelihood of a SDOH intervention project becoming a political football is very real. No one doubts that everyone should have access to medical care and a community that supports safety and well-being. There are often intense debates on what are legitimate system issues vs what are individual responsibilities issues.
Better healthcare requires medical facilities to screen for and document individual patients’ social needs. By screening for SDOH, healthcare providers can better identify needs that negatively affect health outcomes. Using SDOH assessment information helps leverage additional resources to improve patient health outcomes.