Talking about public health can be tricky, because so many of the terms we use sound like jargon. When public health professionals are talking to each other, that may not be a problem; but when we’re trying to explain our work to community members or professionals from other sectors, the words we use might be confusing. Because CHNA 20 is deeply committed to growing collaborative relationships with all members of our communities -- not just the public health experts -- we’ll be periodically sharing simple explanations of complicated-sounding jargon we use when we discuss our work. We hope this will help demystify some of the jargon and make our efforts more understandable and accessible to our communities.
What are Social Determinants of Health (SDoH)?
Social Determinants of Health are the conditions in the places where people live, learn, work, and play that impact health and well-being. They affect people’s health and well-being in a wide variety of ways, and they’re key drivers of health inequities -- the unfair differences in health status or access to health resources between different groups of people.
In other words, you can understand SDoH by thinking about the ways in which people’s health and well-being can be altered by factors like how safe their housing is, how financially stable they are, what kind of education and health care are available to them, and so on.
There are 5 key domains that help define SDoH:
Economic Stability: Are people earning steady incomes that allow them to meet their health needs? The ability to pay for housing, food and health care, and to sustain that level of economic stability over time, is a major factor in the health outcomes of individuals and communities.
Education Access and Quality: Do people in different communities have access to similar levels of educational opportunity, like safe learning environments, high-performing schools, and resources to help them meet their learning needs? Students who grow up with less educational opportunity are less likely to graduate from high school or go to college, which impacts their economic stability as adults. Among the most vulnerable students are children growing up in poverty, children with disabilities, and children who experience routine bullying at school. In addition to the long-term economic effects of poor educational attainment, these groups of students may experience more mental health challenges due to the impacts of trauma on the brain.
Health Care Access and Quality: Do people have access to comprehensive, high-quality health care services? For example, are individuals able to regularly get preventive health care like annual checkups from a primary care provider? Do they have insurance that makes the cost of seeking health care manageable? Can they afford medications and other interventions to help them manage chronic conditions? Do they know where they can get necessary health care services, and is transportation available to help them get there? Are they able to understand their own health status and ask questions as needed? Health literacy, affordability, physical access and cultural competency are all important factors in access to care.
Neighborhood and Built Environment: Are the neighborhoods and environments in which people live safe and healthy? For example, the quality of air and water in a particular community can have dramatic effects on health outcomes. Rates of violence and crime are also determinants of a neighborhood’s impact on residents’ health. Safe transportation, clean air, clean water, access to green spaces and safe places to play and socialize are all priorities for creating healthier neighborhoods.
Social and Community Context: Does everyone have positive, supportive social and community relationships? Factors like racism and other forms of discrimination, incarceration, bullying, community violence and low socio-economic status can all cause people to feel more isolated from others than their peers. Without strong social support and positive personal relationships, people’s mental and emotional health may suffer. Lack of social support can also lead to poorer physical health outcomes as individuals may be less safe, have fewer financial resources to help them get medical care, or lack connections with others that would help them access treatment as needed.
You can learn more about SDoH and the Healthy People 2030 Goals, which seek to address SDoH at a national level, at Health.gov.
What would addressing SDoH look like in real life? How can organizations in our area work towards improving these factors for our residents?
The good news is that, while SDoH are complex and multi-layered issues that impact almost every facet of an individual’s life, there are many ways in which we can all work together to make improvements.
The MA Department of Public Health has identified SDoH as a community priority. Their framework includes addressing six key areas: Built Environment, Social Environment, Housing, Violence and Trauma, Employment and Education. The Blue Hills Community Health Alliance is currently working on projects and initiatives that encompass each of these areas. However, we have created a specific emphasis on improving transportation equity in our region through our BHRCC efforts, because access to safe, reliable transportation is a goal that overlaps with many of these SDoH.
In addition, we encourage all organizations interested in improving SDoH in our region to look into the following frameworks:
Healthy People 2030: Outlines data-driven national objectives to improve health and well-being, including the key areas of SDoH. The national guidelines and goals can inform local efforts and provide practical tools for organizations to use in their work.
Health in All Policies Framework: This framework is a collaborative approach to improving health by including health considerations in all decision-making. The considerations include promoting health, equity, and sustainability; supporting intersectional collaboration; benefitting multiple partners; engaging stakeholders; and creating structural or process change.
Upstream, Midstream, and Downstream Interventions: This online tool helps identify different levels of interventions that impact community health, and focuses attention on ways to shift efforts to “upstream” interventions that will produce large-scale, sustainable changes to benefit whole populations.
In a real-world context, making changes to address SDoH means creating new policies and systems that will narrow the equity gaps between different communities and individuals. Increasing access to high-quality, affordable early education programs is one example of an SDoH-focused intervention. Bullying prevention programming and social-emotional literacy efforts are another. Expanding access to quality nutrition and affordable housing is yet another. In other words, tackling SDoH is the kind of work many of our regional member organizations do every day. Now it’s time for all of us to come together with shared goals and a common understanding of the deep work that needs to be done at every level in order to create long-term, sustainable change that lifts up SDoH in the Blue Hills Region.