What are Social Determinants of Health?

Our health is influenced by a number of elements including biology, access and quality of healthcare, the environment in which we live, work and play, and individual behaviors. Other factors that can influence your health include your educational level and socioeconomic status, as well as your understanding of the medical care you receive. These non-medical factors that impact your well-being are known as social determinants of health.

For almost 15 years, I have worked in a community health center helping the most vulnerable patients manage their health. Understanding all of the components that influence health is essential to helping my patients achieve the best health outcomes. I believe that improving health literacy, which is the ability to find, understand, and use information and services to inform health-related decisions and actions, is the foundation for addressing the social determinants of health. When you better understand the factors that affect your health, you will be able to make informed decisions. Additionally, education can help you be an advocate in your own family and community.

Recently, my patient Barbara (not her real name) came to the clinic for a follow-up appointment. We reviewed her lab work, discussed her current health conditions, and discovered that her diabetes was not improving. She was taking several medications for diabetes, which she reported she took daily. She wanted to know if there were any non-medical factors that affected her ability to manage her diabetes. We talked about exercise and she reported that she consistently went to the gym 4 times a week and incorporated cardio and strength exercises. Next, we talk about her diet. Barbara said she ate breakfast every day (usually yogurt), ate lunch out at work, and ate granola bars as a snack. Then I realized the reason her blood sugar levels were uncontrolled: the foods she thought were healthy had hidden sugars and fats. We spent the rest of the visit reviewing how to read a food label and check food ingredients.

During another patient visit, I was talking to Susan (not her real name) about how to reduce sodium in her diet to help control her blood pressure. Susan told me that she eats everything she can. After more conversation, I realized that she had limited access to food. This recognition allowed me to help her locate food pantries near her home. We also discussed how to choose healthy options at the food pantry.

It is essential to address the social determinants of health. As a doctor, I need to know what is affecting my patients’ ability to manage their medical conditions and stay healthy. This goes beyond asking if they are taking their medications and involves a deeper understanding of their lives. Can they afford the co-payment for the medication? Do they understand the instructions for the medications? Do they know why they are taking medications? Additionally, I need to know if there are external factors that affect your health. Maybe you want them to exercise, but there may not be safe spaces in your neighborhood to walk or ride a bike. They may live in an area with limited access to nutritious foods. They may have unstable housing or other responsibilities that affect how they care for themselves and their health. They may have increased stress or sleep problems, making it difficult to manage their medical condition. All of these things can affect health, and as a doctor, I need to understand these factors, detect them, and help patients address them in ways that improve their health.

While screening questionnaires are common in clinic visits, I prefer to simply get to know my patients and understand their lives outside of the clinic. My job is to help them navigate their health through any barriers they may face. Honest conversations and screening tools for social determinants of health are critical to helping me connect my patients to resources in their communities that provide relief.

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