Key Social Determinants of Health
Socioeconomic Status
Socioeconomic status plays a pivotal role in determining health outcomes. Income level, wealth, occupation, and employment security significantly impact an individual’s access to resources, including healthcare services, nutritious food, and safe housing. Disparities in income and wealth contribute to unequal access to quality healthcare, leading to poorer health outcomes among economically disadvantaged populations.
Education
Education is another critical social determinant of health. Educational attainment not only affects an individual’s knowledge about health and healthy behaviors but also has long-term implications for employment opportunities and income potential. Disparities in education contribute to disparities in health, highlighting the need for educational initiatives that promote health literacy and empower individuals to make informed decisions about their well-being.
Community
The neighborhood and physical environment in which individuals reside significantly impact their health. Communities characterized by limited access to safe parks, recreational facilities, and healthy food options contribute to increased rates of obesity, cardiovascular diseases, and other adverse health outcomes. Moreover, exposure to environmental pollutants and toxins in certain neighborhoods can lead to a higher prevalence of respiratory illnesses and other health conditions. Addressing disparities in neighborhood conditions and ensuring access to a clean and healthy environment are crucial for improving health outcomes and reducing healthcare disparities.
These determinants are not exhaustive as there are several categories and sub-categories of individual characteristics and circumstances that are also considered to contribute to healthcare access and health outcomes.
Health Equity
To dampen the impact of social determinants of health on healthcare access and health outcomes is to improve health equity. Health equity is defined as “[t]he attainment of the highest level of health for all people, where everyone has a fair and just opportunity to attain their optimal health regardless of race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, or other factors that affect access to care and health outcomes.” Though the concept of health equity does not encompass a specific set of guidelines, various organizations and governmental bodies have prioritized certain focuses and goals that serve the general mission of achieving broad health equity.
The World Health Organization (WHO) advances three principles of action to achieve health equity: (1) improve daily living conditions; (2) tackle the inequitable distribution of power, money, and resources; and (3) measure and understand the problem and assess the impact of action. These directives promote sustainable change by addressing structural drivers at all levels.
The U.S. Centers for Medicare and Medicaid Services (CMS) forwards a five-tier priority list, as follows:
Priority 1: Expand the Collection, Reporting, and Analysis of Standardized Data
Priority 2: Assess Causes of Disparities Within CMS Programs and Address Inequities in Policies and Operations to Close Gaps
Priority 3: Build Capacity of Health Care Organizations and the Workforce to Reduce Health and Health Care Disparities
Priority 4: Advance Language Access, Health Literacy, and the Provision of Culturally Tailored Services
Priority 5: Increase All Forms of Accessibility to Health Care Services and Coverage
Similar to the WHO principles, this guidance provides a framework by which large-scale change may be effected by addressing healthcare access directly as well as the underlying causes of disparities relating to social determinants of health.
Modern Tools for Promoting Health Equity
Recognizing the importance of addressing health disparities and promoting health equity, various initiatives and programs are currently underway, such as CMS’s Children's Health Insurance Program (CHIP) Services Quality Improvement Program and Health Insurance Marketplace Quality Initiatives. These broad initiatives aim to tackle the impact of social determinants of health and reduce disparities among diverse populations by providing tools and resources to individuals of disadvantaged groups. By targeting broad areas of concern and implementing comprehensive strategies at a federal level, these initiatives strive to create a more equitable healthcare system throughout the country. However, more targeted efforts have also been undertaken that also target local and community-specific issues, such as the establishment of task forces and the implementation of new technologies.
For example, the Community Preventive Services Task Force was established by the U.S. Department of Health in 1996 and espouses a mission of “identify[ing] population health interventions that are scientifically proven to save lives, increase lifespans, and improve quality of life.” The American Medical Association (AMA) also has a task force called the Center for Health Equity, which was launched in 2019 and seeks “to strengthen, amplify and sustain the AMA’s work to eliminate health inequities—improving health outcomes and closing disparities gaps—which are rooted in historical and contemporary injustices and discrimination.”
Health equity task forces and committees, such as the federally established COVID-19 Health Equity Task Force, bring together experts from various sectors to address health disparities and promote health equity at local, state, and national levels. These multidisciplinary groups work on developing policies, strategies, and recommendations to address social determinants of health and improve healthcare access for marginalized populations and are often better equipped to address unique issues within specific state and local communities, especially during the large-scale vaccination efforts throughout the COVID-19 pandemic.
Innovative health technologies and digital solutions are also being leveraged to promote health equity. Telehealth, for example, has emerged as a valuable tool to improve healthcare access for individuals in remote or underserved areas. One area that stands to benefit from the growth of telehealth is maternity care. Telehealth can serve to furnish maternity care deserts, which are “[counties] in which access to maternity health care services [are] limited or absent, either through lack of services or barriers to a woman’s ability to access that care.” By bridging geographic barriers and expanding the reach of healthcare services, telehealth helps reduce disparities in access to care. Additionally, mobile health applications and digital platforms provide opportunities for health education, self-management, and remote monitoring, empowering individuals to take control of their health regardless of their socioeconomic background. As of February 2022, there are approximately 50,000 mobile health apps listed on the Apple App Store, ranging from apps that promote healthy behaviors to apps that assist with the management of chronic illnesses. Access to accurate and reliable healthcare information is essential for individuals to make informed decisions about their health and seek appropriate care. By ensuring that healthcare information is easily accessible, understandable, and available in multiple languages, communities can bridge the information gap that often exists among marginalized populations.
Key Challenges
Despite conceptual support from higher levels of government and targeted solutions at local and community levels, one of the key challenges to reducing the impact of social determinants of health is inadequate funding for healthcare education, illness prevention, and early detection programs. Insufficient financial resources allocated to these vital initiatives restricts the scope and reach of preventative measures, such as health screenings and vaccinations, which are critical for promoting health equity across all populations. Without sufficient resources, these programs struggle to provide the necessary education, outreach, and access to healthcare services, perpetuating disparities and exacerbating the burdens of illness. To address social determinants of health and promote health equity, it is essential to prioritize and allocate funding to support robust and comprehensive illness prevention and early detection programs.
Conclusion
Reducing healthcare access and health outcome disparities requires sustained commitment, collaboration among stakeholders, and a comprehensive understanding of the complex factors that shape individual communities. Though community-focused remedies are most effective in tailoring solutions to the specific needs of a community, public policy and funding must provide support to ensure that such solutions are practical and sustainable. By prioritizing health equity in policies, practices, and research, communities can achieve a future where everyone has an equal opportunity to live a healthy life, regardless of their background and circumstances.