Social Determinants of Health (SDoH) are the community-wide social, economic, and physical conditions we experience where we are born, work, live, play, and age. These conditions are shaped by a wider set of forces, including power, policies, institutions, resources, and systems beyond an individual's control. These conditions determine an uneven distribution of opportunities for good health, leading to differences in health behaviors and outcomes between communities that are avoidable and unjust. Historical, institutional, and interpersonal racism have contributed substantially to these inequities, such as through policies like redlining, which can lead to poorer health outcomes. These factors are amenable to change through policies and programs designed to repair harms and facilitate improved health outcomes.
There are six SDoH categories as named by the Massachusetts Department of Public Health. Each of the six categories has several sub-categories that provide more context.
Built Environment
- Building Design & Quality: Safety, sanitation, maintenance, and accessibility of buildings that support physical activity and social spaces for people of all ages and abilities
- Community Design: Availability of green and open space, access to healthy food, equitability of zoning laws, access to reliable transportation services and infrastructure, access to health care facilities, amenities (including internet access), institutions, and community connectedness
- Environmental Exposures & Climate Resilience: Water quality, air quality, noise pollution, contaminated sites, disaster preparedness, and community emergency planning & response
Social and Community Environment
- Societal Factors: Policies and programs, cultural narratives
- Community Factors: Social capital, social and cultural norms, social isolation, and social, political, professional exclusion
- Interpersonal Factors: Interpersonal relationships
- Individual Factors: People’s attitudes, beliefs, and existing knowledge as related to health
- Violence and Safety: Intentional/self-directed, interpersonal, community, and collective/political violence. This includes violence based on relationships (sexual, domestic, intimate partner) and identity (targeted violence/hate crime, etc.). Individual, interpersonal, and community safety
Economic Stability & Employment
- Employment: employment status, working conditions and workplace risk factors/safety, job market/availability, benefits, job structure and organizational/management practices
- Financial Resources: income/wages, assets, (generational) wealth
- Poverty: (in)ability to meet basic needs (e.g., food, housing)
Education
- Educational Experience: A person’s access to education (location and affordability), the quality of education, the school environment, the availability of resources within a school, and educational attainment
- Educational Outcomes: The impact education has on a person’s future economic security, social and psychological wellbeing, and health behaviors and knowledge
Housing
- Affordability and Stability: Whether a person can afford and sustain payments for housing and home ownership
- Availability and Access: Whether there are housing options available and accessible, including spaces that support physical activity and socialization for people of all ages and abilities
- Quality: The physical structure and living conditions of housing, including availability of safe, sanitary, accessible housing
- Homelessness: The condition of not having stable housing
Health Care Access
- Access and Quality: Access to high-quality, culturally and linguistically appropriate, and health-literate care
- Health Insurance: Health insurance access, affordability, coverage, and quality
- Health Care Environment: Health care laws, health promotion initiatives, supply side of services, attitudes towards health care, and use of services