Social Determinants of Health

What are Social Determinants of Health (SDoH) and why are they important?

Conditions in which people are born, grow, live, work, and age

Shaped by money, power, and resources

Contribute to health disparities across groups and nations

Health requires more than disease control → need healthy living conditions

What is included in economic stability as a social determinant of health?

Covers four basic areas:

Employment: Access to jobs with a livable wage

Food insecurity: Limited access to adequate food

Housing stability: Consistent, safe housing

Poverty: Limited resources to meet basic needs

What education factors influence health (SDoH)?

Early childhood development: First 5 years are critical for growth and long-term health

High school graduation: Minimum requirement for many jobs and further education

Higher education: Linked to better jobs and healthier lives

Language & literacy: Low literacy or ESL barriers can limit education and health outcomes

What social and community factors influence health (SDoH)?

Civic participation: Voting, volunteering → sense of purpose

Discrimination: Causes stress → contributes to health disparities

Incarceration: Linked to poorer mental and physical health

Social cohesion: Strong relationships & support → better health behaviors

What health and healthcare factors influence health (SDoH)?

Access to healthcare: Timely care → better outcomes; barriers → worse health & higher costs

Access to primary care: Preventive services (vaccines, screenings); supported by insurance

Health literacy: Ability to understand and use health info; low literacy → poor adherence & more ED use

What neighborhood and built environment factors affect health?

Access to healthy foods: Reduces chronic disease risk; food deserts = problem

Crime & violence: Limits activity, increases stress → worse health

Environmental conditions: Pollution → poor health & higher mortality

Housing quality: Safety, air quality, hazards impact health

How do social determinants of health (SDHs) affect health?

Direct effects → Cause hazards that reduce health (e.g., pollution, poor housing)

Indirect effects → Make healthy behaviors harder (e.g., limited healthy food, poor transportation, low healthcare access)

Why are social determinants of health (SDHs) considered complex?

Communities often have both strengths and barriers affecting health

WHO model focuses on structural issues, not just individual choices

How does income inequality affect health in the US?

Lower income → higher prevalence of chronic conditions: stroke, heart disease, arthritis

Life expectancy gap: richest vs. poorest 1% → 10.1 years for women, 14.6 years for men

How do race and socioeconomic status (SES) influence health?

Race affects health even after controlling for SES

Exposure to adversity throughout life impacts health

Some groups have lower income and wealth despite similar education

Structural inequality adds extra burden → stressors, adverse childhood experiences, microaggressions

What are health disparities?

Preventable differences in disease, injury, or health opportunities experienced by socially disadvantaged populations.

What is health equity?

Societal efforts to eliminate avoidable inequalities and provide fair conditions for health for all, especially disadvantaged groups.

How did COVID-19 highlight health disparities in the U.S.?

African American and Hispanic populations were less able to work from home or socially distance.

More likely in front-line or caregiving jobs with limited health coverage or sick leave.

Barriers to vaccine access: limited internet/computers, time, transportation, primary care access, and distance to vaccination sites.

Why does healthy food matter, and what are the concerns with processed food?

Healthy food is essential for good health.

Too much processed food is harmful.

Processed food is cheaper and easier to access, influenced by government policies.

How does hunger act as a Social Determinant of Health (SDoH)?

Food deserts common in lower-income neighborhoods

Healthy food costs more than processed food

How can pharmacies screen for Social Determinants of Health (SDoH)?

Integrate screening into workflow (e.g., med reviews, new patient intake)

Involve students and technicians in the process

Use existing forms or items when possible

Focus on areas where the pharmacy can make a meaningful impact

How can Social Determinants of Health (SDHs) be assessed during patient care?

Collect SDH information at first intake, during MTM, or annual assessments

Use established measures like PRAPARE or Social Needs Screening Tool (short form)

Determine how collected data will be stored and used

Have a process in place for addressing identified obstacles

How should pharmacists communicate about sensitive Social Determinants of Health (SDoH) with patients?

Establish a rationale → Explain why questions about income, transportation, or other personal factors are being asked

Approach with care → Acknowledge sensitivity of the conversation

Link SDoH to health/medication use → Show relevance

Emphasize support → “By understanding your situation, I may offer recommendations or referrals to help with your medications and overall health”

How can pharmacists establish trust when discussing Social Determinants of Health (SDoH)?

Build rapport → Be friendly, caring, and approachable

Base conversation on trust → Sensitive discussions may take time and effort

Use motivational interviewing principles → Avoid telling patients what to do

Explain relevance → Link SDoH factors to health and potential ways to help based on their situation

How should pharmacists approach providing resources when discussing SDoH?

Don’t be nosy → Ask only what you can help with

Focus on patient benefit → Connect questions to referrals or assistance

Have a plan → Know the pathways for resources and recommendations

How can pharmacists address SDoH during routine pharmacy encounters?

Use patient-centered communication to help mitigate SDoH

Support medication adherence and patient education

Address health literacy and medication cost (deprescribe or interchange if needed)

Promote self-efficacy and chronic care management

Improve access by answering health questions

Trust that patients are doing their best

What’s the difference between individual vs. population focus for addressing health disparities?

Individual focus →

Targets highest-risk individuals, often late in disease

Many are left out due to access/insurance issues

Short-term outcomes

Population focus →

Strengthens community assets and resources

Addresses historical inequities

Works beyond the health sector

Long-term outcomes