Social Determinants of Health
Social determinants of health (SDOH) are defined as the conditions in which people are born, grow, live, work, and age. SDOH are shaped by the distribution of money, power, and resources throughout local communities, nations, and the world. Differences in these conditions lead to health inequities or the unfair and avoidable differences in health status seen within and between countries.
Healthy People 2030 includes SDOH among its leading health indicators. One of Healthy People 2030’s five overarching goals is specifically related to SDOH: Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.
Through broader awareness of how to better incorporate SDOH throughout the multiple aspects of public health work and the 10 Essential Public Health Services, public health practitioners can transform and strengthen their capacity to advance health equity. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health, such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.
Long-standing systemic health, social, and economic inequities have put some members of racial and ethnic minority groups, as well as people with lower incomes, at increased risk of getting COVID-19 or experiencing severe illness, regardless of age. In public health emergencies, these conditions can also isolate people from the resources they need to prepare for, and respond to, outbreaks. Some populations are more challenged than others because of SDOH, such as people who experience homelessness, refugee populations, or tribal communities.
The CDC COVID-19 Response Health Equity Strategy provides information on how to improve the health outcomes of populations disproportionately affected by COVID-19.
Increasingly, state, tribal, local, and territorial public health departments identify SDOH as among the critical challenges they face in addressing public health priorities. CDC’s Center for State, Tribal, Local, and Territorial Support (CSTLTS) brings perspectives and insights from health department leaders to inform CDC’s work with SDOH.
CSTLTS supports agency-wide efforts to make SDOH part of the fabric of public health programs, policy, surveillance, and research at the appropriate levels. In collaboration with the Office of the Associate Director for Policy and Strategy and the Office of Minority Health and Health Equity, CSTLTS plays a lead role in supporting and updating CDC’s SDOH website, which catalogues data sources, research, guidance, programs, and policy efforts from across the agency.
Through work with multiple partners to provide technical assistance, resources, and training, CDC supports collaborative assessment and planning efforts of health departments and their community partners. For example, CSTLTS works with the National Association of County and City Health Officials to support the Mobilizing for Action through Planning and Partnerships (MAPP) planning framework, which incorporates health equity into its guidance and practice. The requirements and tools that health departments, hospitals, and others use to guide their collaborative state and community assessment and planning efforts include attention to data and information about health inequities and social and structural determinants of health.
These processes engage populations and multi-sector partners throughout the jurisdiction and yield collaborative plans that lay out priorities and strategies for addressing disparities.
The Public Health Law Program (PHLP), within CSTLTS, has a health equity portfolio that includes research on antidiscrimination or civil rights laws, health-in-all-policies, and research on the role of law as a structural and social determinant of health. PHLP resources relevant to the determinants of health assess laws concerning education, HIV testing, homelessness and housing, environment, economics, nutrition, telehealth, and tribal public health, among others.
CSTLTS partners with the Public Health Institute’s Center for Health Leadership and Practice to support the National Leadership Academy for the Public’s Health (NLAPH). NLAPH offers an innovative style of leadership development by bringing together teams of leaders from multiple sectors who actively engage their communities to improve population health and achieve health equity. The program uses a team-based experiential learning process to solve complex public health issues by working across sectors within a community. The goal is to prepare participants to use innovative ways to drive the adoption of evidence-based practice and policies, support the use of multi-sectoral approaches, and improve health outcomes.
CDC supports the national accreditation program, which is administered through the Public Health Accreditation Board (PHAB). The national standards serve as the basis for the accreditation program and include a significant focus on health equity and SDOH in many of the requirements. This includes areas such as community health assessment, health improvement plans, health promotion, policy development, and internal training efforts. Data from evaluation studies and from accredited sites show that, by striving to meet these standards, health departments are strengthening multi-sectoral partnerships and implementing practices, such as developing health equity policies and establishing agency-wide health equity councils. More information is available from PHAB and the Association of State and Territorial Health Officials.
For more information about SDOH at CDC, visit www.cdc.gov/socialdeterminants