Social Determinants of Health

Social Determinants of Health (SDH) are being recognized as important factors in people health and well-being. They include:

• Economic stability: Poverty, employment, food insecurity, housing instability
• Education: Language and literacy, early childhood education and development
• Social and community: Social cohesion, civic participation, discrimination, incarceration
• Neighborhood and built environment: Access to foods that support healthy eating patterns, quality of housing, crime and violence, environmental conditions
• Health and healthcare: Access to quality healthcare; health literacy.

I’ve been thinking about a useful way to examine SDH in terms of prevention and treatment of health problems that requires patient self-management and engagement.

It seems to me that a good way to begin is by answering two basic questions: What would be the current reality IDEALLY? How does the current reality DIFFER from the ideal and why? How can current realities be transformed to be more reflective of the ideal.

How’s this for a start – Ideally, everyone should:

• Understand their health risks, problems, and suitable ways to deal them
• Have healthy eating patterns and healthy foods
• Exercise properly in a suitable place
• Access a PCP for physical exams, health risk assessments, advice, treatments, referrals
• Have a multidisciplinary care team (as needed) who follow a care plan that improves physical and psychological health through high-value methods
• Have beliefs, emotions and behaviors that result in wise health-related decisions and beneficial actions • Monitor themselves
• Deal with distressing life problems rationally and effectively
• Live in a safe neighborhood with low crime, healthy environmental conditions, and stable housing
• Have competent, compassionate care givers (formal and informal)
• Have good social support from family, friends, community, etc.

Determining what can be done to overcome the obstacles to the ideal should consider the positive and negative qualities of human nature and cultural values, as well as biomedical factors.