Race and Social Determinants of Health

Just as primary care physicians strive to identify the source of a patient’s illness, health and human service professionals must examine all of the possible factors contributing to their client’s behavioral health conditions. These factors can generally be divided into two categories: genetic determinants and social determinants of health (SDOH).

While genetic determinants are a leading cause of many behavioral health conditions, social determinants of health play an equally, if not more important, role. By expanding their knowledge of social determinants of health, clinicians are better equipped to comprehensively address their clients’ behavioral health conditions and develop truly effective treatment plans.

What is Considered a Social Determinant of Health?

According to the World Health Organization (WHO), social determinants of health are the “conditions in which people are born, grow, live, work, and age” that impact their physical and mental health. While there are many social determinants of health, they typically fall into one of five categories: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.

Examples of the social determinants of health that fall within these categories include food security, housing, and trauma. Racism is also a social determinant of health and is intimately connected to many others, instigating new mental health conditions and/or exacerbating existing ones. Health and human service professionals seeking to expand their knowledge of how social determinants of health—and race in particular—influence behavioral health often have many questions, including:

1. Why are Social Determinants of Health Important?

While biological and health behavior accounts for 25% of a population’s health, the other 75% is determined by social determinants of health, including social environment, physical environment, and access to medical care. To develop truly effective treatment plans and improve client outcomes, health and human service professionals must gain an in-depth understanding of both the genetic and social risk factors at play for their clients.

Across the globe, researchers have found a link between social stratification based on ethnicity, class, gender, and age, and an individual’s physical and mental health and wellbeing. According to the WHO, social stratification “engenders differential exposure to health-damaging conditions and differential vulnerability, in terms of health conditions and material resource availability.” 

2. How are the Social Determinants of Health Identified?

Identifying and addressing social determinants of health can pose a daunting task for clinicians. No two clients are exactly alike, and clinicians must assess every facet of a client’s cross-sectional identity, including their race, gender identity, sexual orientation, and socio-economic status to fully understand the social determinants impacting their health. For example, social determinants of health among Black American men will differ from social determinants for Black American women, altering the behavioral health outcomes they may experience.

To effectively identify each client’s social determinants of health, clinicians can follow these three steps:

Choose an Assessment Tool: A clinician must have access to a comprehensive social determinants of health assessment tool to accurately identify all of the social determinants at play in their clients’ lives. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is one of the most common assessment tools deployed within health and human service organizations.

Collect All Relevant Information: Once a clinician has identified the assessment tool they will use, it’s time to implement that tool during intake meetings as well as any meetings with existing clients. Using this tool, they can then collect and integrate all relevant social determinants of health information into their evaluation process.

Create a Workflow: Workflows also play a critical part in the social determinants of health assessment process. As part of an effective workflow, clinicians will identify the community resources available to their clients and make referrals as needed.

3. How Does Race Impact Mental Health?

Many health and human service professionals often wonder, how exactly do social determinants of health, like race, influence mental health disparities? Researchers believe that the most prominent connection between an individual’s racial experience and their health is largely a result of discrimination and its effects on stress.

When an individual experiences discrimination—whether directly, or within broader structures of racism and inequality—it can become a chronic stressor. Chronic stress can, in turn, induce a variety of mental health outcomes, including substance use disorder, depression, and anxiety.

Individuals’ experiences with discrimination, systemic injustice, and violent acts can also lead to racial trauma. Symptoms of racial trauma can look very similar to those associated with other types of traumatic disorders, such as post-traumatic stress disorder, and include hypervigilance, flashbacks, and dissociation. A form of heightened stress, trauma can change the chemical makeup of the brain and lead to emotional dysregulation (difficulty managing anger, anxiety, or sadness), numbness or feeling detached from one’s environment, and impaired reasoning and problem-solving skills. Trauma-based responses, including substance use and depression, can also spiral into suicidality. 

4. How do Race and Ethnicity Affect Healthcare?

Indirect, unfair racial discrimination in healthcare occurs when individuals lack access to physical and mental health care services as a result of their race. This form of racial discrimination is often linked to socio-economic factors that influence where an individual lives, their ability to afford health insurance, and whether or not they can afford to take time off of work for treatment. Health care discrimination statistics published in the U.S. National Library of Medicine state that Black Americans and Hispanic individuals are more likely to be uninsured throughout adulthood than non-Hispanic individuals.

But inadequate access to care isn’t the only barrier to mental health services impacted by one’s race. Direct racial discrimination in health and social care occurs when clinicians—whether consciously or unconsciously—offer less effective treatment to clients based on their race. According to Alan Nelson, committee chair of the National Academies’ Institute of Medicine, “Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable.”