Social Determinants of Health

The Social Determinants of Health (SDoH) is a framework that acknowledges that non-medical factors greatly affect health outcomes. While this concept originated long ago, the SDoH was published by the Wellesley Institute in 2011 in a concept paper, Reducing Disparities and Improving Population Health: The Role of a Vibrant Community Sector. The SDoH has been adopted and adapted by many, including leading organizations in public health, like the World Health Organization and the Centers for Disease and Control. Much has been studied and written about the framework since then, but the core idea is that the conditions in which we live, work, learn, and play have a great impact on our physical and mental health. We know that these conditions are affected and shaped by the distribution of resources, money, and power at global, national, and local levels, and they can serve as either catalysts or barriers to health and well-being.

Because inequities are created when barriers exist that prevent individuals and communities from reaching their full potential to be healthy and well, the Social Determinants of Health framework is useful for identifying and addressing health inequities. The SDoH acknowledges the interconnectedness of our physical health and community conditions in which we live, and the corresponding disparities due to a lack of health equity. As stated in the Wellesley Institute publication, SDoH can be used to engage those outside of the healthcare system—the “community sector, defined as ‘the wide range of not-for-profit organizations whose mandate is to work with and provide services to communities to meet local needs.’” The SDoH framework helps stewards know how their work fits into the larger picture of health and well-being for individuals and communities, and where to prioritize efforts to to best improve and advance equitable well-being.

One of the most difficult things about leveraging the Social Determinants of Health to promote health equity is that in many cases barriers to well-being exist because of conditions that have persisted in the U.S. for years, if not decades. It’s challenging to reverse these long-standing conditions due to their pervasive nature and the way they are deeply embedded in society. For example, racism in the U.S. is systemic and has historically prevented people of color from having the same opportunities as their white counterparts for economic, physical, and mental health. Without health equity, vulnerable populations are at risk for disparate access to community resources and conditions that create well-being because of economic, cultural, racial, or physical characteristics (medical and non-medical factors). Importantly, improved overall population health is not necessarily a sign of increased health equity. Health equity is demonstrated through a decrease in health disparities—worse health outcomes in marginalized groups.

While the Social Determinants of Health framework has been around for decades, more recently various organizations, academic institutions, government agencies, etc. have adapted the framework to match their various organizational structures and workflows. One comparable framework Community Commons advances is often referred to as an updated version of the SDoH—the Vital Conditions for Well-Being Framework. This framework is similar to the SDoH in that the core principle is the acknowledgement that non-medical factors greatly influence our health, and the Vital Conditions framework categorizes these into Seven Vital Conditions that we all need all the time to be healthy and well.

Frameworks like the Social Determinants of Health and the Vital Conditions help advance equitable well-being by acknowledging the interconnectedness of our physical health to the community conditions in which we live, and in turn, how the differences in those conditions contribute to health disparities and highlight ways to improve health equity. The SDoH also encourages collective action and prompts work from stewards across systems and sectors to decrease barriers to conditions that lead to well-being. Adoption of a well-being framework like the SDoH or the Vital Conditions for Well-Being at scale catalyzes alignment across communities, networks, and even nationwide. Healthy People 2030—an initiative that sets broad, ambitious, national goals towards the health and well-being of all people and communities—is one example of this, as they’ve adopted the SDoH framework.