Social Determinants of Health 101 for Health Care: Five Plus Five

Social determinants of health (SDoH) is a relatively new term in health care. As defi ned by the World Health Organization (WHO), SDoH are “the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels” [1]. The social determinants of health also determine access and quality of medical care—sometimes referred to as medical social determinants of health (see Figure 1 for the County Health Rankings model of factors shaping health). Future opportunities may exist in genetics and biological determinants; however, whether modifying these will be as feasible as modifying the social determinants of health is unknown. Although the SDoH easily resonate for clinicians, given their intuitive recognition that health outcomes are aff ected by patients’ conditions outside the clinical walls, clinicians may raise several concerns about involvement in the SDoH. First, they realize that this is not their domain of expertise or current accountability. Second, some are worried that health care systems already have enough to address and should not play a role in eff orts to mitigate or improve the SDoH. Third, they express concern about the limited evidence of eff ectiveness of interventions by health care on the SDoH [2]. There is a viewpoint, however, for health care to fi nd its role in population health [3], and some providers believe there is enough science to support integration of SDoH into health care and are pursuing evidence-informed interventions with community partners [4,5]. Lest we think SDoH are the next panacea in health care, let us consider what we know and what we need to learn about SDoH to achieve the national quality strategy of better care, healthy people/healthy communities, and aff ordable care [6].