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Introduction to Social Determinants of HealthSelf-Study Module
Copyright © 2012–2017 The Regents of the University of Michigan. For questions or permissions please contact [email protected]
Learning Objectives• Define Social Determinants of Health
• Discuss five key areas for Social Determinants of Health, as identified by Healthy People 2020, and its impact on population health
• Define the differences between the upstream and downstream Social Determinants of Health
Definition
The World Health Organization (WHO) defines the social determinants of health as:“The conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels”
Social Determinants of HealthHealthy People 2020
These five key areas (determinants) include:• Economic Stability• Education• Social and Community
Context• Health and Health Care• Neighborhood and Built
Environment
Designed to identify ways to create social and physical environments that promote good health
Advances needed in education, childcare, housing, business, media, community planning, transportation and agriculture
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
https://www.healthypeople.gov/sites/default/files/PhaseI_0.pdf
Social Determinants in the U.S.• Lack of knowledge or understanding on magnitude these determinants
have on population health• Spends less than other countries on non-health social services• There has been an increased awareness that medical care alone is not
enough to improve overall health or reduce health disparities• Highest amount of income inequality than any comparable wealthy and
sizeable country• Highest environmental burden of disease of 12 comparably high-income
countries. This includes pollution, occupational risks, agricultural methods, and food contamination in relation to disease burden
http://www.healthsystemtracker.org/2016/02/a-comparison-of-social-determinants-in-the-u-s-and-comparable-countries/
2016 County Health Rankings
Map displays Michigan’s summary ranks for health factors. Its based on weighted scores for health behaviors, clinical care, social and economic factors, and the physical environment
Lighter shades indicate better performance.
www.countyhealthrankings.org/michigan
Social Determinants of HealthWhy is it Important?
• It’s an approach to achieving health equity– Health equity is defined as everyone having the
opportunity to attain their full health potential– No one is disadvantaged because of social position
or socially determined circumstances
Impact of Different Factors on Risk of Premature DeathRisk of dying before the age of 65 is over three times greater for Americans at the socioeconomic bottom of society
The poorest 8% of our population bear 25% of the burden of excess deaths
Infants born to mothers with less than 12 years of education are twice as likely to die during their first year of life
Lathrop, B. (2013). Policy, Politics & Nursing Practice 14(1). 41-47.
Social Determinants of HealthPublic Health
• Must take social determinants into consideration in order to improve population health
• Still lacking strong public policies• Public health has relied on laws and regulations in the past:
– Sanitation laws– Environmental protection agency– Safety belt requirement– Standardized immunizations– Department of Agriculture– Food and Drug Administration– OSHA
Upstream social factors influence health at each life stage
Upstream, Affect Health Directly or Indirectly
Key Downstream Determinants of
Health
• Knowing when, where and how to intervene• SDOH are not routinely screened for in primary care
settings• Providers may not understand the social determinants
of health and/or what steps to take when identified.• Limited ability to measure upstream factors
Social Determinants of HealthGaps
A CLOSER LOOK
Social Determinants of Health
Social Determinants of HealthSocial and Community Context
• Social support gives people the emotional and practical resources they need
• Belonging to a social network helps people feel cared for, loved and valued and can help support a healthy lifestyle
• Decreased social and emotional support can lead to depression, and higher levels of disability from chronic diseases
• High levels of income inequality will have less social cohesion and more violent crimes
• Discrimination
Social Determinates of HealthEconomic Stability
• Refers to access to material goods and services, including income and wealth accumulated material assets, i.e. home, vehicles etc.– Poverty level– Insecure employment– Increased stress– Food security– Housing stability– May affect health throughout life
Social Determinants of HealthNeighborhood and Physical Environment
• Physical characteristics:– Air and water quality– Exposure to lead paint– Safe place to exercise
• Risk of pedestrian accidents
– Segregation
• May also include:– Transportation– Schools– Medical care – Employment resources
Social Determinants of HealthNeighborhood and Physical Environment
Food• Lack of and variety of nutritional foods leads to malnutrition
and deficiency diseases• The poor tend to substitute cheaper processed foods for fresh
foods• Access to good, affordable food has a greater impact to what
people eat than health education• Availability of useful information about diet and health, is
especially important in early childhood development
Social Determinants of HealthEducation
• Can lead to increased health knowledge and healthy behaviors
• Shapes employment opportunities – major determinate of economic resources
• May affect health by influencing social and psychological factors
• Higher education is usually associated with higher relative social standing
• Early Childhood Development – which includes the physical, social/emotional, and language/cognitive domains of development, each equally important
Social Determinants of HealthHealth and Health Care
• Lack of health coverage– Access– Affordability
• Quality of care– Quality– Appropriate care
• Provider availability or access to primary care– Access
• Provider linguistic and cultural competency• Lack of collaboration with social services
Summary
• Social determinants of health are the conditions in which people are born, grow, live, work and age.
• Social determinants of health refer to the set of factors that contribute to the social patterning of health, disease, and illness
• Addressing social determinants of health is key to improving population health
