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Social Determinants of Health
The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems that impact our health/well-being, functioning, and quality of life. These conditions can be grouped into five aspects of our lives: 1) Education access and quality; 2) Healthcare access and quality; 3) Our neighborhoods and the built environment in those neighborhoods; 4) Social and community context; and 5) Economic stability.[1] Research has shown that each of these aspects is associated with our health, health behaviors, and how we navigate healthcare.
Education access and quality: People with higher levels of education have been shown to be healthier and to live longer. There are many barriers to high quality education and several factors can limit our educational opportunities, such as poverty and social discrimination (e.g. bullying). Low quality education and limited education opportunities can impact our ability to get safe, well-paying jobs which then can limit our ability to protect our health and pay for needed healthcare.
Healthcare access and quality: Since the implementation of the Affordable Care Act (ACA), the uninsured rate for African American/Black people under age 65 decreased by 8 percentage points, from 20 percent in 2011 to 12 percent in 2019. The uninsured rate for Black Americans, however, is still higher than that for White Americans: 12 percent compared to 9 percent. Health insurance is not the only barrier to healthcare; some of us can’t get the healthcare we need when we need it because of issues related to additional out-of-pocket costs (over and above what insurance covers) and because of where we live and the lack of healthcare providers in our area.
Neighborhoods and the built environment: The neighborhoods where we live can have a substantial influence on our health, health behaviors, and well-being. In particular, the quality of the air, water, and other resources we have in our neighborhoods, how safe we feel in our neighborhoods, even the physical and social characteristics (e.g. presence of litter, graffiti, abandoned building) have all been shown to be associated with the health, health behaviors, and well-being of the residents.
Social and community context: The quality and the quantity of our relationships and interactions with family, friends, co-workers, and community members can have a major impact on our health and well-being.[2] Strong social connections have been shown to be associated with lower levels of anxiety and depression and even to how long we live.[3]
Economic stability: In the United States 1 in 10 people live in poverty,[4] with many of us (approximately 4 out of 10) lacking the financial resources to cover basic expenses for three months if we experienced a sudden job loss, a medical emergency or another financial crisis leading to a loss of stable income.[5]
These SDOH are shaped by the distribution of money, power, and resources at global, national, and local levels.
Social Determinants of Health (SDOH) in the Cancer Care Delivery System
Some healthcare delivery systems are prioritizing the identification of the SDOH in their patients and are screening for the social needs patients have as they manage and navigate treatment.[6][7] Social needs are self reported needs that are impacting a patient’s health, ability to participate in research (e.g. clinical trials), and how s/he is navigating cancer care. Examples include social isolation, food insecurity, financial hardship, transportation needs, and housing instability.
SDOH and social needs are also described as “social risks” and are defined by the National Cancer Institute (NCI) as “ adverse conditions or contextual factors associated with poor health.” Social risks and social needs cause substantial barriers to cancer care and contribute to poor health-related outcomes as patients navigate and manage cancer care, especially for patients and survivors from racial/ethnic minority groups, rural areas, and other historically marginalized groups or underserved areas. The NCI recently implemented a webinar series called “Addressing Social Risks in Cancer Care Delivery.” For more information on this webinar series see the following link: https://healthcaredelivery.cancer.gov/social-risks/webinar-series/addressing-social-risks.html
References
- [1] https://health.gov/healthypeople/objectives-and-data/social-determinants-health)
- [2] House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.
- [3] Holt-Lunstad, J. (2022). Social Connection as a Public Health Issue: The Evidence and a Systemic Framework for Prioritizing the “Social” in Social Determinants of Health. Annu Rev Public Health, 43, 29-30.
- [4] Semega, J., Kollar, M., Creamer, J., Mohanty, A. (2019). Income and Poverty in the United States. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2019/demo/p60-266.pdf
- [5] https://scorecard.prosperitynow.org/data-by-issue#finance/outcome/liquid-asset-poverty-rate
- [6] Solomon, Loel S., and Michael H. Kanter. “Health care steps up to social determinants of health: current context.” The Permanente Journal 22 (2018).
- [7] Tucker-Seeley, R. and Shastri, S. Integrating Social Care Into Cancer Care Delivery: Are We Ready? ASCO Daily News Retrieved from https://dailynews.ascopubs.org/do/10.1200/ADN.22.201054/full/
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