The Importance of Considering the Social Determinants of Health

Social determinants have a major impact on health outcomes—especially for the most vulnerable populations. Factors such as a patient’s education, income level and environment must be considered when providing treatment and care.

As the Kaiser Family Foundation noted in recent research: “Based on a meta-analysis of nearly 50 studies, researchers found that social factors, including education, racial segregation, social supports, and poverty accounted for over a third of total deaths in the United States in a year.”

It is therefore essential for primary care providers—such as nurse practitioners educated in FNP programs—to consider social determinants of health to enable more holistic, comprehensive healthcare for the patients and families they serve.

Here, we’ll examine how social determinants of health impact health outcomes and how we can build a better healthcare system together.

The Impact of Social Determinants of Health

According to the CDC, it has been well-established that poverty inhibits access to healthy foods and safe neighborhoods, and that higher levels of education influence better health. The impact of such factors on health is defined by Healthy People 2020 as social determinants of health: “Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” When resources are available to overcome negative social determinants of health, they can have a significant impact on population health outcomes.

However, when such resources are lacking, social determinants can create undesirable circumstances, such as disparities and discrimination. Social epidemiologist Nancy Krieger referred to the influence of discrimination as “embodied inequality,” which includes dynamics of social injustice that lead to poor health outcomes and may impact multiple generations. Even when discrimination is absent, Krieger said that populations “would continue to exhibit persistent disparities reflecting prior inequities.”

Negative social determinants of health can impact both an individual’s knowledge about healthcare and resources, and limit access to them. A growing body of research indicated:

• Children born to parents who haven’t completed high school are more likely to live in environments that contain barriers to health.
• Poor individuals who are white are less likely to live in areas of concentrated poverty than poor racial and ethnic minorities.
• As income decreases, the likelihood of premature death increases.
• There is a direct link between the likelihood of smoking, shorter life expectancy, and lower income.
• The environment in which an individual lives may impact future generations.
• Stress related to disparities has a direct link to health, and often results from overlapping factors.
• Growing evidence highlights the negative impact of stress on both children and adults across the lifespan. Commonly referred to as allostatic load, chronic exposure to social and environmental stressors often results in biological “wear-and-tear” that’s places individuals at higher health risk.

In addition to impacting health, negative social determinants that lead to disparities in health are costly and inhibit the overall quality of care and population health—resulting in added healthcare expenses, loss of productivity, and premature death. According to the Kaiser Family Foundation, 30% of direct medical costs for blacks, Hispanics and Asian-Americans are excess costs and related to health inequities. In addition, the US economy loses an estimated $309 billion annually due to the direct and indirect costs of disparities.

Building a Better Healthcare System

As our population becomes more diverse and at greater risk for poor health outcomes due to the impact of negative social determinants of health, there is a growing need to coordinate services across the care continuum. Connecting and integrating social supports and services into healthcare provision is essential in order to address the broad range of social determinants that play such an important role in health and well-being. Much of this can be achieved through various methods of increased collaboration among healthcare professionals. Experts recommend:

• Recognizing and integrating social factors that influence health-related behaviors and health status to develop more effective treatment plans.
• Assessing and addressing social needs through appropriate referrals to ensure adequate support.
• Developing health-promotion strategies that reach into communities to improve living and working conditions.
• Conducting or supporting ongoing research regarding social determinants of health and determine which strategies may be most effective in improving health outcomes.
• Acting as a resource for local, state, and national policy makers to enable improved health equity for all Americans.

By doing so, healthcare professionals can create a more holistic awareness of the biological, behavioral and social factors that impact health—working together to build a more equitable healthcare system that enables better health outcomes for all.