Strategies to Address Social Determinants of Health

While genetic factors certainly influence one’s health, researchers have begun taking an even closer look at how environmental factors influence one’s wellbeing. Often referred to as the social determinants of health, these factors begin influencing our development the moment we are born — whether we are aware of them or not. But, how can we address social determinants of health and why are social determinants of health so important?

Social determinants of health have been connected to a range of conditions, from substance use disorders to depression, schizophrenia to diabetes. By examining the social factors at play in a person’s life, healthcare professionals can better identify the best course of treatment and intervention.

Defining the social determinants of health

The World Health Organization (WHO) defines social determinants of health as the “conditions in which people are born, grow, live, work, and age” that are shaped by the distribution of money, resources, and power at multiple levels. This definition applies to the social determinants of one’s health as a whole and includes physical and mental health outcomes.

Social determinants of health are typically broken down into two categories: protective factors and risk factors. Protective factors like community safety, supportive relationships, and financial stability tend to lead to positive health outcomes. Conversely, risk factors are more likely to lead to negative health outcomes, and include unsafe living conditions, food insecurity, poverty, and more. Some factors, like income level, may evolve over an individual’s lifetime, turning from a protective factor into a risk factor and vice versa.

What are social determinants of mental health?

The social determinants of mental health reflect inequalities in income, education, healthcare, physical environments, and social support networks, all of which are often intimately connected to one another. While there are countless social determinants of health, the most common examples someone in nursing, social work or another healthcare position might encounter when helping individuals manage their physical and mental health include:

Economic stability

Economic resources directly influence an individual’s access to healthcare, where they live, what food they eat, their stress levels, and the amount of leisure time they have. Education and employment opportunities are also tied to income — individuals without access to a high-quality education often receive fewer high-paying job opportunities, meaning they will have fewer opportunities to increase their income over time. According to researchers, individuals who experience economic instability early in life are more likely to experience psychological distress.

Education

Beyond economic stability, a good education also encourages the development of problem-solving and self-regulation skills. Individuals with strong problem-solving and self-regulation skills are better equipped to manage challenging and stressful situations, enabling them to navigate many other social determinants of health more effectively.

Food security

An estimated 37 million Americans — 11 million of whom are children — are food insecure. Many households lack money for food, cutting or skipping meals and eating unbalanced but affordable meals as a result. Others may have the financial resources to purchase groceries, but reside in food deserts with minimal access to healthy food. Food insecurity has been linked to higher rates of anxiety and mood disorders, especially among females.

Exposure to violence or conflict

Exposure to violence or conflict at any point in life — especially if it is a regular occurance — can significantly impact an individual’s mental and physical health. In fact, early exposure to violence or conflict can lead to years of mental and emotional challenges, making it one of the major social determinants of children’s mental health.

Social norms and attitudes

The social and cultural norms that define one’s upbringing, such as distrust in healthcare providers or disregard for mental health, can directly impact an individual’s access to healthcare.

Housing

An unstable housing environment is a critical social determinant of health. Unsafe neighborhoods, dangerous housing structures, and cramped spaces all influence a person’s mental health and often their physical safety as well.

Social support

Strong social support networks encourage emotional and psychological wellbeing by providing a safe space for individuals to share concerns and learn how to manage stress. Without a strong support system, many individuals become overwhelmed as they attempt to navigate life’s challenges alone.

Identifying the social determinants of health

Strategies for addressing the social determinants of health are an integral part of every comprehensive behavioral health treatment plan. While identifying which social determinants are at play for each individual can be challenging — especially given that so many of them are interconnected — several steps can help guide clinicians along the way:

1. Establishing a baseline

All healthcare professionals must have a strong foundational understanding of their clients’ environments, allowing them to establish a baseline of insights that inform future clinician-client conversations.

2. Conducting a social awareness screening

Once a baseline understanding has been established, practitioners conduct what is often referred to as a “social awareness screening.” A social awareness screening is a conversation in which a clinician asks questions designed to assess any risk factors evident in their client’s environment. The clinician must employ careful listening and empathy during this time to help their client feel comfortable sharing personal information that could be critical to their treatment.

3. Making informed diagnoses

Clinicians who are well informed of the impacts associated with social determinants of mental health are poised to make more informed diagnoses and create more impactful treatment plans for their clients. Understanding social determinants also enhances communication and trust between clinicians and clients during the treatment process. This can translate into higher client satisfaction and, in turn, better client retention.

How to address the social determinants of mental and physical health

Effectively addressing the social determinants of health involves a multi-faceted approach centered on collaboration. Collaboration with community members, housing authorities, schools, religious institutions, and other social networks and associations allows health and human service providers to better support their clients.

As part of this collaborative effort, providers must be aware of the resources available to clients on both a local and federal level. Many individuals are unaware that they are eligible for federal programs like Medicaid, the Supplemental Nutrition Assistance Program, and Temporary Assistance for Needy Families. By making this connection, providers can quickly help improve existing social determinants of health for their clients.

Given that many social determinants of health are systemic, health and human service professionals hoping to address these factors more comprehensively are encouraged to get involved at a policy level. By contributing their unique insights and perspectives to advocacy, providers can expand their impact on the social determinants of health beyond the scope of their individual clients.

Improve client outcomes

When health and human service professionals are well informed of the social factors that shape their clients’ past and present experiences, they are better equipped to provide exhaustive treatment plans that can improve their clients’ safety and wellbeing. Working collaboratively with federal and local agencies, these professionals can more effectively support their clients along the treatment journey.