Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
SDOH can be grouped into 5 domains:
Economic Stability
Education Access and Quality
Health Care Access and Quality
Neighborhood and Built Environment
Social and Community Context
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Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [date graphic was accessed], from //health.gov/healthypeople/objectives-and-data/social-determinants-health
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Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life. Examples of SDOH include:
- Safe housing, transportation, and neighborhoods
- Racism, discrimination, and violence
- Education, job opportunities, and income
- Access to nutritious foods and physical activity opportunities
- Polluted air and water
- Language and literacy skills
SDOH also contribute to wide health disparities and inequities. For example, people who don't have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.
Just promoting healthy choices won't eliminate these and other health disparities. Instead, public health organizations and their partners in sectors like education, transportation, and housing need to take action to improve the conditions in people's environments.
That's why Healthy People 2030 has an increased and overarching focus on SDOH.
How Does Healthy People 2030 Address SDOH?
One of Healthy People 2030’s 5 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.”
In line with this goal, Healthy People 2030 features many objectives related to SDOH. These objectives highlight the importance of "upstream" factors — usually unrelated to health care delivery — in improving health and reducing health disparities.
More than a dozen workgroups made up of subject matter experts with different backgrounds and areas of expertise developed these objectives. One of these groups, the Social Determinants of Health Workgroup, focuses solely on SDOH.
Explore Research Related to SDOH
Social determinants of health affect nearly everyone in one way or another. Our literature summaries provide a snapshot of the latest research related to specific SDOH.
Read SDOH literature summariesLearn About Other Efforts to Address SDOH
Across the United States, people and organizations at the local, state, territorial, tribal, and national level are working hard to improve health and reduce health disparities by addressing SDOH.
The practice of health promotion and diseases prevention is supported by numerous theories and concepts. In order to understand and explain health behavior and to guide the selection, development, and implementation of treatments, program planners employ theories and models.
- Theory- is defined as a set of concepts, definitions, and propositions that explain or predict events or situations by illustrating the relationships between variables. Theories must be applicable to a broad variety of situations. They are, by nature, abstract, and don’t have a specified content or topic area. Like empty coffee cups, theories have shapes and boundaries, but nothing inside. They become useful when filled with practical topics, goals, and problems. A theory presents a systematic way of understanding events or situations.
- Models- is defined as a variety of theories to better understand a problem in a certain setting or context. They are not always as specified as theory
- Concepts- Concepts are the major components of a theory; they are its building blocks or primary elements. Concepts can vary in the extent to which they have meaning or can be understood outside the context of a specific theory.
- Constructs -refer to concepts that are developed or adopted for use in a particular theory.
- Variables are the empirical counterparts or operational forms of constructs. They specify how a construct is to be measured in a specific situation. Variables should be matched to constructs when identifying what should be assessed in the evaluation of a theory-driven program.
- Theory provides planners with the skills they need to go beyond perception to create and assess health behavior and health promotion interventions that are based on behavioral understanding.
- A road map for analyzing problems, creating appropriate interventions, and evaluating their success is provided by theory.
- Theory can also be used to describe the dynamics of health behaviors, including change processes and the influences of the numerous elements that influence health behaviors, such as social and physical environments.
- Theory can also assist planners in determining the most appropriate target audiences, change strategies, and evaluation outcomes.
- Theoretical approaches are used to examine solutions to the questions of "why," "what," and "how" health issues should be handled. They explain the nature of targeted health behaviors by seeking answers to these issues. That is, theory directs the search for reasons why people engage in or refrain from certain health behaviors; it assists planners in determining what they need to know before developing public health programs; and it suggests how to develop program strategies that reach target audiences and have an impact.
Physiotherapists play an important role in promoting public health. Traditionally, the focus of health promotion by physiotherapist has been on disease prevention, rehabilitation and changing the behavior of individuals with respect to their health. However, their role as promoters of health is more complex, since the change in health-related behavior is as a result of numerous interaction. physiotherapist must understand essential ideas of health behavior change in order to help clients change their behaviors, just as they must understand theories of motor control when preparing interventions to improve motor performance.
Theories and Models of Behavior Change[edit | edit source]
Selected theories and models that are used for health promotion categorized into
- Individual models of health behavior -Health belief model, Transtheoretical Model (Stages of Change), theory of Reasoned Action and theory of Planned Behavior.
- Models of interpersonal health behavior- Social cognitive theory
- Community and group models of health behavior change - ecology model, PRECEDE-PROCEED and planning model
The health belief model is a theoretical model that can be used to guide health promotion programs. It is used to explain and predict individual changes in health behaviors. It is one of the mostly widely used models for understanding health behaviors. The Health Belief Model (HBM)addresses the individual’s perceptions of the threat posed by a health problem (susceptibility, severity), the benefits of avoiding the threat, and factors influencing the decision to act (barriers, cues to action, and self-efficacy).
Key Element of Health Belief Model[edit | edit source]
The model focus on individual beliefs about health conditions, which predict individual health-related behaviors. The factors that influence health behaviors include
- perceived susceptibility – an individual perceived threat to sickness or disease.
- Perceived severity- belief of consequence.
- Perceived benefits – potential positive benefits of action
- Cues to action- perceived barriers to action, exposure to factors that prompt action.
- Self-efficacy- confidence in the ability to succeed.
Overweight and obesity have become a major public health concern around the world. HBM can be used to examine factors affecting the behavioral intention of weight management. Behavioral intention of weight management will be positively influenced by perceived threat, perceived benefits, and self-efficacy in dieting and exercise. Perceived barriers will negatively influence behavioral intention of weight management. Perceived threat will mediate relationship between cues to action and behavioral intention of weight management.
Stages of Change Model (Transtheoretical Model)[edit | edit source]
The transtheoretical model (TTM) is a modern psychological framework for explaining the adoption and maintenance of purposeful health behaviors. Precontemplation, contemplation, preparation, action, and maintenance are the five main stages of change in the TTM referred to as the temporal and motivational aspects of change .
TTM proposes that behavior change occurs in stages throughout time, with the cognitive and behavioral processes that individuals engage in at different phases of change serving as the mechanisms of change. Individuals will also consider the benefits and drawbacks of participating in physical activity. As individuals progress through the stages of physical activity habit modification, they will experience an improvement in self-efficacy and TTM has been widely used to determine physical activity correlations.When individuals view the benefits and drawbacks of physical activity. As individuals progress through the stages of physical activity habit modification, they will typically experience improved self-efficacy.
Theory of Reasoned Action/Planned Behavior[edit | edit source]
It focuses on the creation of a system of observation of two groups of variables: attitudes, which are defined as a positive or negative feeling in relation to the achievement of an objective; and subjective norms, which are the exact representations of an individual's perception of the product's ability to achieve those goals.
In the context of tobacco use, application of reasoned action/planner behavior implies that an individual's conduct is determined by their intention to engage in the behavior, which is a result of the individual's:
Attitudes: A person's beliefs about the characteristics and consequences of using tobacco (or quitting), as weighted by their assessments of these characteristics and consequences.
Subjective Norms: A person's beliefs about the approval or disapproval of tobacco use by important others (normative beliefs), as weighted by their motivation to follow these important others' wishes.
Perceived Behavioral control refers to a person's perception of control over tobacco use in the presence or absence of barriers and facilitators to quitting.
One of the most widely used models in health promotion, it addresses both underlying determinants of health behavior and the methods of promoting change and was based on the interaction between individual and environment. Focus on the way in which an environment shapes behavior.
Basic components of social cognitive theory
- Reciprocal determinism
- Environmental context
- Individual
- Behaviour
HoMBReS is a community-based program aimed at lowering the risk of HIV and other sexually transmitted illnesses among Latino men in rural areas of the United States. The program trains "Navegantes" (Navigators) who deliver knowledge and risk reduction resources to the target community, based on the Social Cognitive Theory.
The ecological model refers to as the interaction between, and interdependence of, factors within and across all levels of a health problem. It highlights people’s interactions with their physical and sociocultural environments.
Levels of Ecological Models[edit | edit source]
Ecological models recognize multiple levels of influence on health behaviors including:
- Intrapersonal/individual factors-which influence behavior such as knowledge, attitudes, beliefs, and personality.
- Institutional and organizational factors- including the rules, regulations, policies and informal structures that constrain or promote healthy behaviors.
- Community factors- such as formal or informal social norms that exist among individuals, groups, or organizations, can limit or enhance healthy behaviors.-
- Public policy factors- including local, state and federal policies and laws that regulate or support health actions including early detection, control and management.
Project HEART (Health Education Awareness Research Team) used an ecological model to design a health promotion and disease prevention program to address cardiovascular disease risk factors. The project uses a community health worker (CHW) promotora model to provide services