Social Determinants of Health: Key Concepts and Frameworks

Social determinants of health (SDOH)

Non-medical factors that impact health, such as social norms, racism, economics, climate, and politics.

Five key areas of SDOH

Social and community context, healthcare access and quality, education access and quality, economic stability, and neighborhood/built environment.

Example of a factor in education access and quality

Availability of disability accommodations or funding differences between schools.

Example of a factor in economic stability

Job security or time constraints preventing doctor visits.

Example of a factor in neighborhood and built environment

Food deserts or air pollution.

Percentage of health outcomes determined by medical care

Only 10-20%.

Percentage of health outcomes from socioeconomic, environmental, and behavioral factors combined

About 80-90%.

Influence of social norms and racism on health

They create systemic barriers that limit access to care, education, and opportunity.

Why is zip code a better determinant of health than DNA?

It reflects environmental conditions, access to care, schools, and neighborhood safety.

Relationship between property taxes and school funding

Schools are primarily funded through local property taxes—wealthier areas have better-funded schools.

Definition of a food desert

An area with limited access to affordable and nutritious food.

What is redlining?

Discriminatory housing practice that denied loans or insurance to residents in certain neighborhoods based on race.

Effect of white flight on health resources

It moved wealth and tax revenue to suburbs, reducing resources for urban communities.

Three components of a healthy community

Affordable housing, quality education, and safe public spaces.

What is 'Health in All Policies' (HiAP)?

A collaborative approach integrating health considerations into decision-making across all sectors.

Importance of partnerships in HiAP

They allow sectors to share funding and align goals to improve health.

How can individuals reduce health inequity outside public health work?

Educate themselves, advocate for change, build community relationships, and vote.

Meaning of 'poor people are subsidizing us' by William Foege

The poor often bear the health burdens created by systemic inequities that benefit wealthier populations.

What is individual health literacy?

The ability to find, understand, and use health information to make decisions.

What is organizational health literacy?

The degree to which organizations enable individuals to access and use health resources equitably.

Three literacies needed for public health literacy

Science, civic, and health literacy.

Prevalence of low health literacy in the U.S.

About 9 out of 10 adults struggle with it.

Consequences of low health literacy

More ER visits, hospital stays, lower treatment adherence, and higher mortality.

Strategies to improve health literacy

Use plain language, user-friendly materials, and verify understanding with closed-loop communication.

What is 'closed-loop communication'?

Confirming the receiver understood the message accurately.

Meaning of 'living room language'

Explaining medical information in simple, conversational terms.

Why is health literacy an economic issue?

Low literacy leads to higher healthcare costs and inefficient resource use.

Health Impact Pyramid

A framework illustrating the levels of impact on health, from individual effort to population-level impact.

Individual effort required

Increases as you move up the Health Impact Pyramid.

Population-level impact

Increases as you move down the Health Impact Pyramid.

Five levels of the Health Impact Pyramid

Counseling/education → clinical interventions → long-lasting preventive interventions → changing context → socioeconomic factors.

Greatest population impact

Socioeconomic factors.

Most individual effort

Counseling and education.

Health disparities

Unfair, systematic, socially produced differences in health outcomes.

Systematic health disparities

They stem from social structures that disadvantage specific populations.

Six approaches to reducing inequity

Data/surveillance, evaluation, partnerships, community engagement, infrastructure, and policy/law.

Disproportionate rates of HIV

African Americans (13% of population, ~50% of new HIV cases).

Outcomes of discrimination for LGBTQIA+ youth

Higher bullying, drug use, dating violence, and suicide rates.

Behavioral health

The study of how behavior, social, and cultural factors affect health.

Social Norms Approach

Behavior is influenced more by perceived norms than actual norms.

Self-efficacy

One's belief in their ability to succeed in specific actions.

Health Belief Model

Assumes behavior change depends on perceptions of risk, severity, benefits, barriers, and self-efficacy.

Five components of the Health Belief Model

Perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy.

Transtheoretical Model

A model of stages of behavior change (Precontemplation → Contemplation → Preparation → Action → Maintenance).

Criticism of the Transtheoretical Model

People don't always move through the stages linearly.

Harm reduction

Strategies that reduce the negative consequences of risky behavior without requiring full abstinence.

NAMI

National Alliance on Mental Illness.

Behavior influence on chronic disease prevalence

Unhealthy behaviors (smoking, inactivity, poor diet) increase chronic disease rates.

Leading causes of death in the U.S.

Cardiovascular disease and cancer.

Atherosclerosis

Plaque buildup in arteries from fat, cholesterol, and clotting materials.

Risk factors for cardiovascular disease

Smoking, poor diet, and inactivity.

Cancer in public health terms

A disease caused by uncontrolled cell growth and interference with normal function.

Public health strategies for reducing cancer risk

Reducing fat intake, avoiding carcinogens, vaccination (e.g., HPV), limiting radiation exposure.

Diabetes

A condition where the body doesn't make or use insulin properly.

Type 1 vs Type 2 diabetes

Type 1 = autoimmune, non-preventable; Type 2 = lifestyle-related, preventable.

Percentage of adults with diabetes unaware of their condition

About 1 in 5.

Preventability of Type 2 diabetes

It's linked to behaviors like diet, exercise, and weight management.

Importance of prevention for chronic diseases

Prevention is key for reducing the incidence of chronic diseases.

Epidemiology

The study of disease distribution and determinants in populations.

Epidemiologic triad

Agent, host, and environment.

Communicable diseases

Infectious and transmissible diseases.

Noncommunicable diseases

Chronic diseases not spread person-to-person.

Incidence rate

The rate of new cases in a population over time.

Prevalence

The total number of existing cases in a population.

Mortality rate

The rate of death in a specific population over time.

Attack rate

The proportion of people who become ill among those exposed: (ill ÷ total exposed) × 100.

Units for incidence and prevalence

Incidence = rate (person-time); prevalence = proportion (%).

Difference between incidence and prevalence

Incidence = water flowing in; prevalence = water already in the tub.

Endemic

Usual, constant presence of a disease in an area.

Epidemic

Occurrence of disease above expected levels.

Pandemic

Worldwide epidemic.

Cluster

Group of disease cases related in time or place.

Epidemic curve

Shows the number of cases over time; reveals disease pattern and source.

Common-source epidemic curves

Single exposure event.

Propagated epidemic curves

Person-to-person spread.

Epidemiologic surveillance

Continuous collection and analysis of health data for action.

Active surveillance

Investigators seek data.

Passive surveillance

Data is reported voluntarily.

Schwann's ice cream outbreak

Caused by Salmonella from egg residue in transport trucks.

Rates in epidemiology

Used to compare disease occurrence between populations fairly.

Descriptive epidemiology questions

Who, where, and when.

Analytical epidemiology

Examines the cause-and-effect relationship (why).

Difference between descriptive and analytical studies

Descriptive = describes patterns; analytical = tests hypotheses.

Observational studies

Studies where researchers do not manipulate variables; they observe natural exposures.

Case-control study

Compares people with a disease (cases) to those without (controls) to identify past exposures.

Odds ratio

Measures the strength of association between exposure and disease.

Cohort study

Follows exposed and unexposed groups over time to measure disease incidence.

Relative risk

The ratio of disease incidence in exposed vs. unexposed groups.

Experimental study

Researchers control exposures using random assignment and placebos.

Randomization and placebos

Reduce bias by controlling confounding and participant expectations.

Framingham Study

A long-term cohort study on cardiovascular disease risk factors.

John Snow's contribution

Used descriptive and analytical epidemiology to trace cholera to contaminated water.

Main types of bias in studies

Selection bias, recall bias, and loss to follow-up.

Confounding

A third factor that distorts the true relationship between exposure and outcome.

Ethics of randomized trials

Some exposures are too dangerous or unethical to assign experimentally.