November 23, 2021

What Are Social Determinants of Health?

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"We recognize that until we can reduce the negative impact of a person's environment, we can't get them healthy," says David Henderson.

Social determinants of health (SDoH) are factors in a person’s life and environment that impact their health outcomes in positive or negative ways. These economic and social conditions are all connected and can have a detrimental snowball effect for individuals and entire populations.

There are numerous social determinants of health, but they all fall within six major categories:

Let’s take the first one as an example: financial wellness. As anyone who has experienced economic hardship will tell you, you constantly worry, “Where is my next meal going to come from?” or “How am I going to feed my kids?” It’s extremely stressful to get up every day with that burden, and that chronic stress is a direct path to early heart attack, stroke, hypertension, depression, and anxiety—all because of just that one factor.

Social determinants of health deficits have longstanding impact

What’s even more powerful is that your stress today has a negative impact on your health decades later. For example, we have known for a long time that when young children experience even a brief period of food insecurity, they suffer health and mental health consequences throughout their life, and they can actually pass this risk on to their own children. In other words, these experiences may activate or deactivate genes and have a negative health effect, which is known as epigenetics.

What’s even more powerful is that your stress today has a negative impact on your health decades later.

The U.S. government is supposed to help and support our most vulnerable, but it instead can keep millions of people with disabilities in a chronic state of poverty and deprivation, which goes against the notion of getting people well. For instance, as explained by a Talk Poverty article, if you are disabled and unable to work, the U.S. government may give you $800 a month. But if your rent is $500 and your bills are $200, you’re left with $100 to eat for the month. That’s impossible. Yet the moment you try to break out of that system by working part time, the government starts offering less money or taking money back. It’s hard to get out and people are in a chronic state of stress.

Finding solutions for our patients

At Boston Medical Center (BMC), we add a social determinants of health screener to every patient’s medical record, which helps our providers remember to ask about things like housing and transportation.

The traditional hospital model normally doesn’t spend a lot of time on these areas, but we recognize that until we can reduce the negative impact of a person’s environment, we can’t get them healthy. If during screening, we identify an unmet social need, we can help that patient access services to get food or move them to a better living situation. We can find solutions.

The Health Equity Accelerator at Boston Medical Center

With the launch of the Health Equity Accelerator, we are addressing SDoH on a systemic level with intentionality—turbo-charging the foundational work and focus already in existence across BMC and community partners. The Health Equity Accelerator was created by a group of nearly 100 clinicians, researchers, and administrators at BMC to help eliminate the health equity gap that exists in the U.S. Broadly, our work will roll out in three phases:

  1. Identify the health disparities within our own patient population. For every disparity we identify, we will also research what factors are contributing. We have to first understand the problem to know how to fix it.
  2. Come up with solutions. Again, we’ll do the research to make sure each intervention we recommend indeed achieves a better outcome.
  3. Create new medical literature. For every disease and disorder doctors treat, it’s almost guesswork with our patients, because studies have never been done on them. For example, the literature may say that Black people have high rates of hypertension because of too much salt in the diet, but maybe a bigger factor is their being exposed to violence in their neighborhoods.

We’re a safety-net hospital, and we’re also an academic medical center, so we must bring the data, look at it, and develop the right interventions for populations with health inequities. We feel a great responsibility to improve health outcomes for the most vulnerable. We’re excited about this work. We just have to get it right.

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About the Author

David C. Henderson, MD

David C. Henderson is Psychiatrist-in-Chief at Boston Medical Center.

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