What Are the Social Determinants of Health?

Medically Reviewed by Neha Pathak, MD on September 09, 2021
6 min read

The social determinants of health (SDOH) describe the conditions in the place where you were born, live, work, learn, play, worship, and age. They’re made up of a large range of things that impact your health and quality of life.

These conditions directly affect your well-being in positive and negative ways. For example, a neighborhood may have mass transit that makes it easy to get around and cuts down on pollution. But it may also lack grocery stores where people can buy healthy foods.

With more focus on SDOH, public health organizations and their partners in each area can take action to improve the conditions in people’s environments.

To help organizations take the needed action, the SDOH Workgroup has been established with the cooperation of government agencies, including:

  • Office of Disease Prevention and Health Promotion (ODPHP)
  • National Institutes of Health (NIH)
  • Centers for Disease Control and Prevention (CDC)
  • Health Resources and Services Administration (HRSA)
  • National Center for Health Statistics (NCHS)

Members of the SDOH Workgroup are experts in various areas, like health equity, health disparities, economics, vulnerable populations, and other SDOH matters. This group created objectives related to the social determinants of health.

There are five overall domains within the SDOH:

  • Economic stability
  • Health care access and quality
  • Social and community context
  • Education access and quality
  • Neighborhood and built environment

Economic stability

One in 10 people in the United States live in poverty. Many can’t afford healthy food, health care, or shelter. Those with stable employment are more likely to be healthy. But even those who find secure jobs may not be able to keep their position or may not make enough money to afford the things they need to stay healthy. In addition, people with injuries, disabilities, or conditions like arthritis might face limits in their ability to work certain jobs.

Career counseling, employment programs, and child care programs can help people find and maintain their jobs. Organizations and government policies can also help people pay for housing, food, health care, and education to improve their quality of life.

To help achieve these goals, experts are working to find ways to:

  • Lower the number of people living in poverty
  • Boost employment in working-age people
  • Raise the number of children living with at least one parent who works full time
  • Lessen household food insecurity and hunger, especially for children

Health care access and quality

Around 1 in 10 people in the United States don’t have health insurance. These people are less likely to have a primary health care provider and might not be able to afford the medications and medical services they need. It’s crucial that insurance coverage rates go up so that more people have access to important preventive care and treatment for chronic conditions.

Without a primary care provider, you may miss out on critical health care services, like cancer screenings. In some cases, you may live too far away from providers who offer them. It’s very important that experts improve access to and communication with health care professionals so that more people can get the care they need.

To boost access to full, high-quality health care services, experts aim to:

  • Heighten the number of people with health insurance
  • Boost the number of people with a regular primary care provider
  • Boost the number of adults who get recommended preventive health care
  • Reduce the number of new HIV infections and diagnoses
  • Heighten the number of pregnant women who receive early and adequate prenatal care

Social and community context

Your relationships with your family, friends, co-workers, and community members can play a major role in your health and well-being. But many people deal with challenges and dangers that are out of their control, like discrimination, an unsafe neighborhood, or issues with affording the things they need.

Healthy relationships within your home, your community, and at work can help give you support to meet these challenges. Not everyone gets healthy levels of support from their loved ones. Specific efforts can help provide social and community support to those in need that can boost their overall well-being.

To grow social and community support, SDOH experts seek to:

  • Grow the number of adolescents who have an adult they can talk to about serious problems
  • Heighten the number of adults who talk to friends or family about their health
  • Boost the number of adults who use information technology (IT) to track health care data or communicate with providers
  • Reduce the number of kids with a parent or guardian who has served time in jail
  • Grow the number of children whose parents read to them at least 4 days per week

Education access and quality

Those with access to good education throughout their lives are usually healthier than people without. Education gives you a chance at upward mobility, which can allow you to get to a better financial situation to access quality health care. Education also allows you to stay informed about how to care for your health. Those with a less formal education may not be as prepared to tell the difference between reliable and inaccurate health information.

Studies have also shown that higher education helps people keep a higher-paying job with fewer safety risks. Those with more education usually have the resources to afford better housing in safer areas as well as expert doctors.

To help children and adolescents perform well in school, experts hope to:

  • Grow the number of high school students who graduate in 4 years
  • Heighten the number of high school graduates in college the October after graduating
  • Boost the number of students with disabilities who are usually in regular education programs
  • Grow the number of fourth graders with reading and math skills at or above the proficient level

Neighborhood and built environment

The neighborhood that you live in has a direct effect on your health and well-being. Many people in the United States live in an area with high rates of violence, unsafe air or water, or other health and safety dangers. Low-income families or racial and ethnic minorities are more likely to live in areas with these risks. Also, many people are around workplace risks like secondhand smoke or loud noises, which can affect their health.

Policy changes at federal, state, and local levels can lower these risks and promote better health.

To help create neighborhoods and environments that promote health and safety, policy experts are working to:

  • Grow the number of people whose water supply meets Safe Drinking Water Act regulations
  • Lower health and environmental risks from hazardous sites and released pollution
  • Lower the number of people exposed to secondhand smoke
  • Lower the rate of minors and young adults committing violent crimes
  • Boost trips to work made by mass transit
  • Boost the number of adults with broadband internet

Within each SDOH, there are many objectives within a variety of specific topics. These objectives are measurable and focus on high-priority public health issues. Experts use data to track how each objective has progressed over time. They group them based on their growth:

Baseline only. This refers to goals that don’t yet have any data besides initial baseline information. Experts don’t know if there’s been any progress made in these areas yet.

Target met or exceeded. Experts can show that they’ve met this objective or exceeded the goal.

Improving. Data shows that there’s progress toward the goal for this objective.

Little or no detectable change. No growth has occurred to fulfill this objective.

Getting worse. Experts found that they’re farther from their goal than they were at the start.

Developmental objectives. These are high-priority health issues with some evidence, but they don’t have reliable baseline data yet.

Research objectives. These are public health issues that carry a high health or economic burden or have a large inequality between population groups. But these don’t yet have much evidence.