Social Determinants of Health

As defined by the World Health Organization (WHO), SDOH are the nonmedical factors that influence health outcomes.They are the conditions in which people are born, grow, live, work and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.

The SDOH have an important influence on health inequities the unfair and avoidable differences in health status seen within and between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.

The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:

Income and social protection

Education

Unemployment and job insecurity

Working life conditions

Food insecurity

Housing, basic amenities and the environment

Early childhood development

Social inclusion and non-discrimination

Structural conflict

Access to affordable health services of decent quality.

The social determinants of health also determine access and quality of medical care terminants of health.

People with higher levels of education are more likely to be healthier and live longer.

Healthy People 2030 focuses on providing high-quality educational opportunities for children and adolescents and on helping them do well in school.

Children from low-income families, children with disabilities, and children who routinely experience forms of social discrimination like bullying are more likely to struggle with math and reading. They’re also less likely to graduate from high school or go to college. This means they’re less likely to get safe, high-paying jobs and more likely to have health problems like heart disease, diabetes, and depression.

In addition, some children live in places with poorly performing schools, and many families can’t afford to send their children to college. The stress of living in poverty can also affect children’s brain development, making it harder for them to do well in school. Interventions to help children and adolescents do well in school and help families pay for college can have long-term health benefits

Healthy People 2030 focuses on improving health by helping people get timely, high-quality health care services.

About 1 in 10 people in the United States don’t have health insurance. 1 People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses. Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider. Other times, it’s because they live too far away from health care providers who offer them. Interventions to increase access to health care professionals and improve communication in person or remotely can help more people get the care they need.

People live in have a major impact on their health and wellbeing. Healthy People 2030 focuses on improving health and safety in the places where people live, work, learn, and play.

Many people in the United States live in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks. In addition, some people are exposed to things at work that can harm their health, like secondhand smoke or loud noises. Interventions and policy changes at the local, state, and federal level can help reduce these health and safety risks and promote health. For example, providing opportunities for people to walk and bike in their communities like by adding sidewalks and bike lanes can increase safety and help improve health and quality of life.

Public health infrastructure provides the necessary foundation for all public health services from vaccinations to chronic disease prevention programs to emergency preparedness efforts. Healthy People 2030 focuses on creating a strong public health infrastructure. The Public Health Infrastructure objectives address high-performing health departments, workforce development and training, data and information systems, planning, and partnerships.

A strong public health infrastructure includes a capable and qualified workforce, up-to-date data and information systems, and agencies that can assess and respond to public health needs. While a strong infrastructure depends on many organizations working together, public health departments play a central role in the nation’s public health system. Federal agencies rely on a solid public health infrastructure in state, tribal, local, and territorial jurisdictions.

are avoidable inequalities in health between groups of people within countries and between countries. These inequities arise from inequalities within and between societies. Social and economic conditions and their effects on people’s lives determine their risk of illness and the actions taken to prevent them becoming ill or treat illness when it occurs.

Examples of health inequities between countries:

The infant mortality rate (the risk of a baby dying between birth and one year of age) is 2 per 1000 live births in Iceland and over 120 per 1000 live births in Mozambique;

The lifetime risk of maternal death during or shortly after pregnancy is only 1 in 17 400 in Sweden but it is 1 in 8 in Afghanistan.

The poorest of the poor, around the world, have the worst health. Within countries, the evidence shows that in general the lower an individual’s socioeconomic position the worse their health. There is a social gradient in health that runs from top to bottom of the socioeconomic spectrum. This is a global phenomenon, seen in low-, middle- and high-income countries. The social gradient in health means that health inequities affect everyone.

For example, if you look at under-5 mortality rates by levels of household wealth you see that within counties the relation between socioeconomic level and health is graded. The poorest have the highest under-5 mortality rates, and people in the second highest quintile of household wealth have higher mortality in their offspring than those in the highest quintile. This is the social gradient in health.

Why do we need SdoH ?

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.

The development of a society, rich or poor, can be judged by the quality of its population’s health, how fairly health is distributed across the social spectrum, and the degree of protection provided from disadvantage as a result of ill-health. In the spirit of social justice, the Commission on Social Determinants of Health was set up by the World Health Organization (WHO) in 2005 to marshal the evidence on what can be done to promote health equity, and to foster a global movement to achieve it.

As the Commission has done its work, several countries and agencies have become partners seeking to frame policies and programmes, across the whole of society, that influence the social determinants of health and improve health equity. These countries and partners are in the forefront of a global movement.

The Commission calls on the WHO and all governments to lead global action on the social determinants of health with the aim of achieving health equity. It is essential that governments, civil society, WHO, and other global organizations now come together in taking action to improve the lives of the world’s citizens. Achieving health equity within a generation is achievable, it is the right thing to do, and now is the right time to do it.

Health financing is fundamental to the ability of health systems to improve human welfare sustainably. However, financing is more complex than a simple Generation of funds. To understand the nature of indicators that can be used to monitor and Evaluate health systems financing requires explicit assessment of the expected goals.

It is defined as the “function of a health system concerned with the mobilization, Accumulation and allocation of money to cover the health needs of the people, individually and Collectively, in the health system… the purpose of health financing is to make funding available, as Well as to set the right financial incentives to providers, to ensure that all individuals have access to effective public health and personal health care”.

The ability of a country to meet its health goals depends largely on the people responsible for organizing and delivering health services. Evidence of a direct and positive link between the numbers of health workers and population health outcomes has been demonstrated by studies. Many countries, however, lack the adequate human resources needed in healthcare. This may be due to; limited production capacity, migration of health workers, poor mix of skills and demographic imbalances. The formulation of national policies in pursuit of human resources for the development of the country’s health system requires sound information. Additionally, building knowledge and databases on the health Workforce requires coordination across sectors. WHO is working with countries and partners to strengthen the Global evidence base on the health workforce — including gaining consensus on a core set of indicators for monitoring the stock, distribution and production of health workers.

According to the WHO framework for health systems , a well-functioning health system ensures equitable Access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and costEffectiveness.

To achieve these objectives, the following are Needed:

National policies, standards, guidelines and regulations that support policy.

Information on prices, the status of international trade agreements and the capacity to set and negotiate Prices.

Reliable manufacturing practices when they exist in-country and quality assessment of priority products; Procurement, supply and storage, and distribution systems that minimize leakage and other waste; and Support for rational use of medicines, commodities and equipment, through guidelines and strategies to Assure adherence, reduce resistance, maximize patient safety and training.

Reliable information is the foundation of decision-making across all health system building blocks. It is essential for health system policy development and implementation, governance and regulation, health Research, human resources development, health education and training, service delivery and financing.

The health information system provides the underpinnings for decisionmaking and has four key functions: Data generation, (ii) compilation, (iii) analysis and synthesis, and (iv)communication and use. The health Information system collects data from health and other relevant sectors, analyses the data and ensures their Overall quality, relevance and timeliness, and converts the data into information for the decision-Making.

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