social determinants of health
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Introduction
- social determinants of health is defined by the World Health Organization as the conditions in which people are born, grow, work, live, & age encompassing the forces & systems shaping conditions of daily life[5]
- Centers for Medicare & Medicaid Services & state Medicaid agencies have incorporated social needs as an element of care innovation[5]
Etiology
Includes:
- how people live
- access to health care
- health insurance
- problems affording medications
- economic stability (income, financial resources)
- housing, home environment, neighborhood
- living with a partner, marriage
- domestic safety, domestic abuse
- transportation
- food insecurity
- access to health care
- climate & environmental exposures
- education* (educational environment)
- recreation & socialization (social isolation, social support)
- unemployment, work (occupational environment)
- race, gender[6]
- psychosocial stress
Clinical significance
- Life expectancy due to social determinants of health (points)[6]
| Category | points |
|---|---|
| female | +4 |
| never married | -5 |
| previously married | -3 |
| high school education only | -5 |
| college degree | +2 |
| white | +1 |
| hispanic | +2 |
* education, race, gender & marriage account for 18 years of life-expectancy[6]
- it might be argued that race & gender (sex) are more genetic than social
Complications
Management
- consider depression when addressing social determinants of health
- less education, being unmarried, unemployment, lack of health insurance are associated with higher PHQ-9 scores[3]
More general terms
Additional terms
References
- ↑ He J et al. Social, behavioral, and metabolic risk factors and racial disparities in cardiovascular disease mortality in U.S. adults: An observational study. Ann Intern Med 2023 Aug 15; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/37579311 https://www.acpjournals.org/doi/10.7326/M23-0507
- ↑ Buitron de la Vega P, Losi S, Sprague Martinez L et al Implementing an EHR-based Screening and Referral System to Address Social Determinants of Health in Primary Care. Med Care. 2019 Jun;57 Suppl 6 Suppl 2:S133-S139. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31095052
- ↑ 3.0 3.1 Califf RM, Wong C, Doraiswamy PM Importance of Social Determinants in Screening for Depression. J Gen Intern Med. 2022 Aug;37(11):2736-2743. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34405346 PMCID: PMC9411454 Free PMC article.
- ↑ Morelli V Social Determinants of Health: An Overview for the Primary Care Provider. Prim Care. 2023 Dec;50(4):507-525. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37866828 Review.
- ↑ 5.0 5.1 5.2 Drake C, Batchelder H, Lian T et al Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework. BMC Health Serv Res. 2021 Sep 17;21(1):975. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34530826 PMCID: PMC8445654 Free PMC article.
- ↑ 6.0 6.1 6.2 6.3 Bergeron-Boucher MP, Callaway J, Strozza C, Oeppen J. Inequalities in lifespan and mortality risk in the US, 2015-2019: a cross-sectional analysis of subpopulations by social determinants of health. BMJ Open. 2024 Aug 5;14(6):e079534. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39106997 Free article. https://bmjopen.bmj.com/content/14/6/e079534
- ↑ Hudgins V Social Determinants of Health: The Physician's Role. MedPage Today. July 29, 2024 https://www.healthecareers.com/medpage/career-resources/on-the-job/social-determinants-of-health-the-physicians-role