Addressing SDOH will drive lasting and improved health outcomes.

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Social determinants of health (SDOH) are the life and environmental conditions that people experience in their daily lives and are key aspects in determing their health, functioning and outcomes. The U.S. Office of Disease Prevention and Health Promotion broadly categorizes SDOH into five areas: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment and social and community context.

Conceptually, SDOH play an independent yet significant role in people’s lives apart from the clinical care they receive, as they are key aspects of wellness concomitant to receiving timely medical attention. For example, communities or patients that live in food deserts are less likely to have access to fresh groceries and more likely to rely on highly processed foods, leading to poorer health outcomes despite having access to regular primary care. Another common example is transportation; patients may be in a community rich with medical infrastructure, but may not be able to afford transportation to their appointments, posing them the same challenge as not having access at all.

Studies indicate that SDOH impact overall health outcomes significantly. The World Health Organization explains this phenomenon across multiple domains. For example, it indicates that those with access to higher education experience longer life spans and better health than those without access in a given population. Another example it cites is the negative impact of wealth-related inequality on pediatric mortality. As the organization also explains, “increasing investments by just 0.1% of GDP in each of social protection, labour market and housing and community policies could markedly improve health for 150 000 people in a country of 40 million within four years.” This impact is significant.

But why is solving the SDOH problem so hard?

Because there is no easy answer. While health experts may urge patients to be more compliant with medications, or visit their primary care physician more frequently, or eat healthier foods, these aspects which are often routine for many people are luxuries for those fighting against SDOH barriers. For example, those without easy access to transportation or who rely on public transportation may have significant challenges in maintaining regularity for appointments. Those with socioeconomic challenges may not be able to take time off from work to go to the doctor; especially in the US, where the majority of non-urgent healthcare services are largely closed on the weekends, this poses a significant challenge for patients that have inflexible jobs. Another example is housing; patients that do not have stable homes may not be able to maintain regular medication schedules, let alone exercise routines or healthy food habits.

What can be done?

From a systemic perspective, more funding and policies should be devoted to better ascertain ways to solve many of these problems at their root cause. Health systems and innovation centers should also be incentivized to help resolve these issues; for example, ride-sharing companies have made significant efforts in helping address key transportation issues for patients. For healthcare professionals, addressing healthcare barriers and gaps beyond pure medical needs at every visit is critical. By doing so, patients can receive care that takes into account their holistic needs.