Social determinants of health (module 7)

Social determinants of health (SDOH):

The conditions where people are born, live, learn, work, play, worship, and age that affect health, functioning, quality of life, and health risks.

Macro factors

Broad social, economic, political, and environmental conditions that influence health across whole populations.

Micro factors

More immediate factors that directly affect a person’s health, such as behaviors, stress, blood pressure, cholesterol, or access to care.

Health outcomes:

Results such as disease, injury, disability, functioning, quality of life, and death

5 factors of SDOH

• economic stability

• education access and quality

• health care access and quality

• neighborhood and built environment

• social and community context

economic stability

having adequate income, employment, food, housing, and the ability to pay bills

Education access and quality

access to quality education, literacy, graduation, college opportunities, and learning support.

Health care access and quality

Being able to obtain affordable, timely, culturally appropriate, high-quality health services.

Neighborhood and built environment:

Conditions where people live, including housing, transportation, parks, pollution, safety, food access, and environmental hazards.

Social and community context:

Relationships, support systems, discrimination, family structure, social cohesion, and involvement in the community.

Health disparities

Preventable differences in health outcomes experienced by groups that face social, economic, or environmental disadvantage.

Ethical research

Research must protect participants’ rights, safety, privacy, and ability to choose whether to participate

Informed consent

Participants must voluntarily agree to a study after receiving understandable information about its purpose, risks, benefits, and procedures

Institutional Review Board (IRB):

A committee that reviews research involving people to make sure it meets ethical standards 

Nazi medical experiments

Nazi doctors performed harmful, nonconsensual experiments on concentration-camp prisoners during the 1940s.

Willowbrook State School study

Children with intellectual disabilities were exposed to hepatitis research at a New York institution during the 1950s.

Puerto Rico Pill Trial

Women were not properly told they were in an experimental contraceptive-pill trial or informed about possible dangerous side effects.

Holmesburg Prison experiments

Researchers tested tranquilizers, antibiotics, and other chemicals on incarcerated people in Philadelphia.

Tuskegee Study

From 1932–1972, the U.S. Public Health Service studied syphilis in 600 Black men, including 399 with syphilis and 201 without it.

Bad blood

Researchers told Tuskegee participants they were being treated for “bad blood,” a local term used for illnesses such as syphilis, anemia, and fatigue.

Tuskegee harm

The men did not receive proper treatment for syphilis and did not give informed consent.

Tuskegee incentives

Participants received medical exams, meals, and burial insurance, which did not make the unethical study acceptable.

Tuskegee legacy

The study contributed to mistrust of medical and public-health institutions, especially within Black communities.

National Research Act of 1974

This law strengthened protections for people in research after the Tuskegee Study.

Belmont Report (1979)

Ethical guidance for research that emphasizes respect for persons, beneficence, and justice.

Labor-force participation

The percentage of people working or actively looking for work.

Educational attainment

The highest level of education a person has completed, which often affects job options and income.

Inflation adjusted earning have ________ the past 20 years 

increased

Working-age education statistic

About 43% of U.S. adults ages 25–64 had at least a bachelor’s degree in 2024, so the statement that about 50% do is false.

Income

Money earned through work or other sources that affects a person’s ability to meet basic needs.

Inflation-adjusted earnings:

Earnings measured after accounting for changes in prices over time

Economic inequality

Unequal distribution of income and wealth, which can create unequal opportunities for good health

Progressive tax system

Higher income levels are taxed at higher rates

Tax bracket

A range of income taxed at a specific rate; only the income within that range receives that rate.

Rural communities

Rural areas may face barriers such as fewer jobs, transportation limits, fewer health services, and limited economic growth.

Adverse childhood experiences (ACEs)

Potentially traumatic events before age 18 that can harm health and well-being across the life course.

ACE categories

ACEs include abuse, neglect, and household dysfunction or household challenges.

Physical abuse

Intentional physical harm to a child

Emotional abuse

Behaviors that damage a child’s emotional well-being, such as humiliation, rejection, or threats.

ACE score

A score from 0–10 based on how many ACE categories a person reports experiencing.

CDC-Kaiser ACE Study

A landmark study of more than 17,000 U.S. adults that showed ACEs are common and linked to later health outcomes

CDC-Kaiser ACE Study

almost ⅔ reported at least one ACE 

Toxic stress from ACEs has a direct effect on brain development, resulting in changes in

Decision making, Learning and growth, Forming healthy relationships

Dose-response relationship (ACE)

As the number of ACEs increases, the risk for negative health and well-being outcomes generally increases.

Preventing ACE 

• Strengthen economic supports to families

• Ensure a strong start for children

• Teach skills

• Connect youth to caring adults and activities

• Intervene to lessen immediate and long-term harms

Early reading

Reading with family members supports language, learning, school readiness, and later academic achievement.

Fourth-grade reading proficiency

A large percentage of U.S. fourth graders score below proficient, showing unequal learning opportunities

Income and reading

Fourth graders who are economically disadvantaged are more likely to score below proficient in reading than those who are not economically disadvantaged.

Individual behavior vs. conditions

Not eating healthy” may reflect SDOH barriers rather than simply a lack of motivation or knowledge

Life expectancy

The average number of years a person is expected to live based on current death rates

Life-expectancy inequity

Life expectancy can differ widely between nearby neighborhoods because of unequal social, economic, and environmental conditions

Cross-sector collaboration

Public health works with sectors such as housing, education, transportation, and communities because health is shaped outside the doctor’s office too