#PrepYourHealth Discussion Guides
Social Determinants of Health
Social determinants of health (SDOH) are non-medical factors that influence health outcomes. They are the conditions in which people are born, live, learn, work, play, worship, and age, and the wider set of forces and systems shaping the conditions of daily life.
SDOH are grouped by Healthy People 2030 into five key areas.
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context
About This Discussion Guide Series
CDC’s Office of Readiness and Response (ORR) helps U.S. communities prepare for, respond to, and recover from emergencies with evidence-based recommendations, technical assistance, and resources.
ORR created these discussion-based activities to help public health departments develop “whole community” plans that consider the impacts of SDOH on personal health preparedness and response.
What is a Discussion Guide?
A discussion-based activity is like a discussion-based preparedness exercise. It follows a facilitated process for evaluating preparedness and response plans, procedures, partnerships, and planning considerations. Its purpose is to help health departments and communities to
- better understand how conditions associated with SDOH affect how people prepare for and respond to emergencies.
- identify gaps in emergency planning, procedures, and partnerships associated with the impacts.
- think of ways to build new and leverage existing partnerships in the whole community to reduce or remove barriers to personal health preparedness for and response to emergencies.
A discussion-based activity involves an appointed facilitator and invited participants. Participants include traditional response partners, such as public health departments, healthcare systems, and emergency management agencies, and nontraditional support partners, such as community- and faith-based organizations.
The goal of these discussion-based activities is to engage the whole community in efforts to
- understand the needs and capabilities of the community.
- create opportunities and conditions for everyone to prepare for and respond to emergencies to their full potential.
Only by taking a whole community approach can communities improve personal and public health preparedness, response, and resilience.
The phrase “whole community” appears a lot in preparedness materials. It means emergency preparedness, response, and recovery are shared responsibilities.
Whole community includes:
- Individuals and families, including those with access and functional needs
- Faith-based and community organizations
- Nonprofit groups
- Schools and academia
- Media outlets
- All levels of government, including state, local, tribal, territorial, and federal partners
The discussion guides have the following limitations:
- The guides assume that SDOH impact personal health preparedness and response.
- The guides assume that facilitators and participants understand SDOH or will learn about them before the discussion.
- The guides are a starting point for addressing the impacts of SDOH on personal health preparedness and response. They are one of the tools available to help practitioners address SDOH.
- The scenario and discussion questions do not address all key issues in the key areas. Examples and evidence of SDOH impacts and interventions are likely to evolve with additional research and experience.
- The usefulness of the information gathered from the discussions depends on who is invited to participate. SDOH affect everyone. The effects are more negative for some people than others. Invite as many members of the whole community as possible to participate in the discussion and/or contribute to the conversation in other ways, such as through a survey.
Use this framework to help you plan and conduct discussion-based activities in the #PrepYourHealth Discussion Guides: Social Determinants of Health series.
These activities are for facilitated use by small groups. Groups can hold discussions in person, over e-mail, on video conferencing, or through a combination of methods.
Consider assembling a small planning team. Assign the following key roles to people who can help plan for and facilitate a discussion-based activity.
The coordinator “runs the show.” They oversee the planning, including logistics, and conduct of the discussion-based activity. The coordinator chooses the facilitator, subject matter expert (SME), and note taker.
The facilitator leads the discussion-based activity. They keep participants focused on activity objectives and the discussion moving without rushing through the questions. An effective facilitator
- keeps discussions on track and drives play to meet exercise objectives.
- controls group dynamics and manages strong personalities.
- speaks competently and confidently without dominating the conversation.
- has subject-matter expertise or experience.
- has an awareness of local plans and procedures.
Subject Matter Expert
The SME plays an important role in the discussion-based activities. The SME is someone with an understanding of SDOH and knowledge of their disproportionate impacts on populations in the community.
The SME can help to guide the activity (e.g., asking follow-up questions and citing real-life examples) and ensure they are plausible and meet activity objectives.
The note taker is an optional but recommended role. The note taker records what is said during the discussion.
This allows others to fully participate in the discussion (e.g., actively listen and ideate follow-up questions).
Participants can also take notes for use after the activity.
Many video conferencing platforms allow for recording meetings and can provide transcripts. It is recommended that you get each participant’s permission to record the discussion.
The table below provides suggested agencies or organizations to include in the discussions.
|Response Individuals & Organizations||Support Individuals & Organizations|
|Emergency management agencies||Volunteer Organizations Active in Disaster (VOAD)|
|Public health departments||Faith-based and community organizations|
|Health care systems||Faith and community leaders|
|Emergency medical service providers||Community service and nonprofit groups|
|Elected public officials|
The organizations you invite to a discussion will depend on the SDOH being discussed. Inviting non-traditional partners to the activity, particularly those that support or are trusted agents of the populations that are most affected by the SDOH, is important to success.
The prework questions are meant to help participants better understand and identify the impacts of SDOH in their community. Your answers to the prework questions will help you
- answer the discussion guide questions.
- identify non-traditional organizations to invite to the discussion.
The coordinator, in consultation with the facilitator and SME, chooses which of the following options will produce the best results:
- Distribute the discussion guide and guest list to participants before the activity. Use the scheduled time to share prepared answers and follow-up questions.
- Do not distribute the discussion guide to participants before the activity. Use the scheduled time to answer the questions in real-time.
These discussion-based activities are for facilitated use as a “lunch and learn” or “brown bag”-type activity. These types of activities typically last about 60 minutes.
Participants are not required to answer all discussion questions. They just need to answer enough questions to get to the heart of the matter: how to leverage positive impacts and how to remove or reduce barriers related to the SDOH when preparing for and responding to a mass evacuation.
Here are some things for you to consider:
- Allow a maximum of 10 minutes for participants to address each question and follow-up questions.
- If you choose to share the discussion guide beforehand, participants will come in ready to talk about the issues. That will help decrease the length of the activity.
- The activities do not have to be limited to just one session. The coordinator may choose to conduct more than one session to cover more situations and discussion questions.
- A suggested agenda is provided. Planning teams are encouraged to develop agendas specific to their discussion-based activities.”
- If you choose to share a discussion guide beforehand, consider using an online format (e.g., Google Docs, SharePoint) to collect participants’ answers. Collect their answers before the activity to share with the group during the discussion.
Before the Discussion
The coordinator should take the following step before the discussion:
- Decide the date, time, and location for the facilitated activity. If done virtually, determine the format to be used. Ensure that most, if not all, participants have access to that format.
- Choose a facilitator.
- Choose an SME.
- Choose a note taker.
- Prepare an attendee list that includes contact information for all participants.
- Send out invitations.
- Prepare copies of the agenda for all participants. Determine when and how to distribute copies to participants (e.g., electronically or in person).
- Assemble necessary technology resources (e.g., virtual meeting login, e-mail list) and supplies (e.g., paper, pens, large index cards) for the activity. Use brainstorming tools (e.g., transcripts, recordings, virtual whiteboards) to capture the real-time thoughts of participants (if applicable).
After the Discussion
Consider working as a group to write a summary and analysis of your discussion. Your written record might
- summarize the group discussion based on collected answers to the questions.
- identify ways SDOH might impact personal health preparedness for and response to evacuations in your jurisdiction.
- suggest ways the whole community can create opportunities and conditions for everyone to prepare for and respond to emergencies to their full potential.
Use this report as you might use an after-action report to identify gaps and opportunities for improvement.
The following agenda is a suggestion, not a requirement. Planning teams are encouraged to develop agendas specific to their discussion-based activities.
|Step 1: Opening||
|Step 2: Situation presentation||
|Step 3: Facilitated discussion||
|Step 4: Conclusion||
|Step 5: Documentation & after action||
Before the Discussion
Answer the prework questions before using the social determinants of health (SDOH) discussion guides. The following are intended to help discussion guide users give informed answers to questions asked during the discussion-based activities.
- How does _________________________ (fill in the SDOH) affect your community every day?
- From your perspective, what populations or groups in your community experience the most negative impacts from _________________________ (fill in the SDOH)?
- From your perspective, how might negative impacts from _________________________ (fill in the SDOH) affect people’s opportunities to prepare for and respond to emergencies?
- Regarding those who are disproportionately affected, what lessons have you learned from past emergency responses?
- What were your areas for improvement?
- What were your successes?
- What new partnerships did you build?
- Considering the answers to these questions, who should you invite to your discussion? Why should you invite them?