Advancing Health Equity: A Guide to Language, Narrative and Concepts (PDF) refers to social determinants of health (or SDOH) as the underlying community-wide social, economic and physical conditions in which people are born, grow, live, work and age.
Social determinants of health are not experienced equally by people and are often inextricably linked to each other. For example, education and access to transportation can impact employment opportunities, and one’s neighborhood location can impact access to healthy food options. These determinants and their unequal distribution according to social position result in differences in health status between population groups that are avoidable and unfair. The profound impact of SDOH can persist across generations and drive health inequity based on race, ethnicity, and socioeconomic status.
Social determinants of health also affect a wide range of health, functioning, and quality-of-life outcomes and risks. They serve as an underlying contributor to multiple conditions, including obesity, heart disease, and diabetes—as well as health care expenditures and premature mortality.
At the 2019 AMA Annual Meeting of the House of Delegates, policy was adopted recognizing health as a basic human right.
The policy “Health, In All Its Dimensions, Is a Basic Right” emphasizes that:
(1) enjoyment of the highest attainable standard of health, in all its dimensions, including health care as a basic human right; and (2) that the provision of health care services, as well as, optimizing the social determinants of health as an ethical obligation of a civil society.”
Another AMA policy supports payment reform policy proposals that incentivize screening for social determinants of health and referral to community support systems.
Why physicians should know patients’ social conditions
The AMA’s Strategic Plan to Embed Racial Justice and Advance Health Equity affirms that addressing social determinants of health strengthens health care systems’ ability to improve quality across all domains while reducing health equities. It also presents the relationship between structural determinants of health and social determinants of health. Structural determinants address the broader issues of the climate, societal norms, macroeconomic social/health policies and systems of power. These determinants negatively impact social determinants of health for people who have been historically marginalized and ultimately produce health inequities.
The AMA STEPS Forward™ module Social Determinants of Health: Improve Health Outcomes Beyond the Clinic Walls looks at why addressing social determinants of health beyond clinic walls is crucial for achieving health equity. “If we’re really going to get to health improvement broadly in this country, it’s going to be when we marry what we do in the office with work our organizations might be able to do in the communities to improve the conditions under which people live, work and play that actually determine health,” said David Ansell, MD, MPH, senior vice president for community health equity and internal medicine physician at Rush University Medical Center in Chicago.
The AMA Ed Hub™ module, “What Are Social Determinants of Health?” says that to better address factors from a patient’s lifestyle and unmet needs that may negatively impact their health and wellbeing, physicians need to dig in deeper than a standard social history Q&A, and uncover any underlying social and economic factors that may influence health outcomes.
An article in the AMA Journal of Ethics points out that distinguishing between health outcomes related to genetics and social determinants is a critical skill to which medical students should be exposed. It is important to acknowledge that race is a social (not biological) construct and that therefore racism—not race—contributes to health inequities between groups.
Social determinants of health & health systems
An AMA Council on Medical Services report, “Health Plan Initiatives Addressing Social Determinants of Health” (PDF) adopted at the November 2020 AMA Special Meeting outlined what needs to be done at the health system level to address health inequities and social determinants of health. The report said that addressing social determinants of health requires an “all-hands-on-deck” approach that is not limited to stakeholders within the health care system. New and continued partnerships among all levels of government, the private sector, philanthropic organizations, and community- and faith-based organizations are critical.
The AMA STEPS Forward toolkit, “Social Determinants of Health: Improve Outcomes Beyond the Clinic Walls,” provides eight steps that practices can take to address social determinants of health. These include:
- Understanding and engaging the community
- Engaging key leadership
- Assessing the practice’s readiness
- Selecting and defining a plan
- Assessing SDOH at the patient level
- Linking patients to SDOH resources
- Evaluating and refining
- Celebrating success
Learn more about health equity education on the AMA Ed Hub™ featuring CME from the AMA’s Center for Health Equity and curated education from collaborating organizations. To earn CME on the AMA’s “Prioritizing Equity” videos, visit the courses page on AMA Ed Hub™.
- Advancing Health Equity: A Guide to Language, Narrative and Concepts
- AMA’s strategic plan to embed racial justice and advance health equity
- Social determinants of health topics
- How to improve screening for social determinants of health
- Social determinants of health: What medical students need to know
- JAMA: Machine Learning–Based Models Incorporating SDOH vs Traditional Models for Predicting In-Hospital Mortality for Heart Failure
- Addressing Social Determinants of Health (CME available)
- Stanford Medcast: COVID-19 Mini-Series—Social Determinants of Health (CME available)
- AMA Journal of Ethics: How Is Colonialism a Sociostructural Determinant of Health in Puerto Rico?
- AMA STEPS Forward® webinar: Social Determinants of Health
Reviewed by: Fernando De Maio, PhD, vice president of health equity research and data use, Center for Health Equity, AMA; professor of sociology, DePaul University.
Reviewed on: Aug. 1, 2022