What Are the Social Determinants of Trauma?

Many leaders in health and human services have heard of trauma-informed care, which involves creating systems that provide safety for trauma survivors while minimizing the risk of re-traumatization. Many others have also heard of the social determinants of health, the conditions in the environment that affect a wide range of health, functioning, and quality-of-life outcomes and risks. But the intersection of these two concepts is rarely considered, even though they interact with each other constantly.

Healthy People 2020 categorizes the social determinants of health (SDOH) into 5 key categories:

• Economic Stability
• Education
• Social and Community Context
• Health and Healthcare
• Neighborhood and Built Environment

Each of these realms of SDOH can impact, or be impacted by, the experience of trauma. In order for health and human service organizations to give well-rounded care to the individuals they serve, they must understand how each can influence the other.

Trauma is a Social Determinant of Health

Experiencing trauma itself can be considered a social determinant of health. Several studies in recent years have found a connection between experiencing traumatic events and physical health outcomes. In fact, traumatic events can actually change the chemical makeup of the brain and increase the risk for developing certain physical ailments, including digestive problems, diabetes, chronic pain, and heart disease.

The Adverse Childhood Experiences (ACEs) Study was the first large-scale study to show the physical impacts of trauma on the body. This study focused on specific instances of trauma: instances of abuse, neglect, and household challenges (e.g. substance use in the household, domestic violence). The study found a correlation between the number of ACEs experienced and adverse health outcomes. Individuals who experience 4 or more ACEs had an increased risk for sexually transmitted infections, cancer, diabetes, and heart disease.

Social Determinants of Health Impact Trauma

The ACEs study also notes that other environmental conditions affect the health of individuals. According to the CDC, “ACEs and associated conditions, such as living in under-resourced or racially segregated neighborhoods, frequently moving, and experiencing food insecurity, can cause toxic stress (extended or prolonged stress).” All these associated conditions are considered to be social determinants of health.

Some social determinants can increase the risk that an individual will experience trauma. Examples of this include:

• Poverty – Those who live in poverty are often surviving daily in vulnerable living conditions, with consistently limited access to food, water, and shelter. This mental and emotional stress can act as a traumatic experience for many individuals. Individuals living in poverty are also more likely to experience traumatic events such as life-threatening accidents, physical assault, and sexual assault.
• Neighborhood Crime and Violence – Experiencing neighborhood crime or violence can increase the likelihood of experiencing post-traumatic stress disorder (PTSD) symptoms. One study found that 43% of patients at a Chicago hospital trauma center experienced signs of PTSD – over half of these individuals had been gunshot victims. Other reports of living in neighborhoods with high rates of violent crimes increased the likelihood of those residents being diagnosed with PTSD.
• Racism – Discrimination, systemic injustice, and violent acts against racial groups based on attitudes of superiority held by the dominant group can result in race-based or racial trauma. Racial trauma can lead to similar outcomes as any other traumatic event. Black and Latino Americans have a higher rate of lifetime PTSD as compared to white Americans. Additionally, recent events surrounding public images of police brutality and the disproportionate death rate of Black Americans due to COVID-19 has mental health advocates worried about complex trauma and the climbing rate of suicide among Black Americans.

How Can Organizations Address Trauma and SDOH?

Combining the knowledge gained from understanding social determinants of health and trauma-informed care can help providers increase protective factors to mitigate exposure to trauma and the environmental factors that can contribute to it. Some ideas for interventions and implementing this knowledge include the following:

• Advocate for policies and programs that strengthen economic supports to families and individuals who are at high-risk of experiencing trauma due to their social determinants.
• Connect youth to caring adults and activities, such as mentoring programs or after-school programs.
• Practice cultural competency and cultural humility within and outside your organization, and encourage continuous learning around working with marginalized communities and reducing implicit bias.
• Create partnerships with health providers in your community to bring awareness to trauma and social determinants of health, provide your services as a resource to their patients, and collaborate on solutions to address these issues.
• Emphasize the resilience of those in your care who have experienced trauma and those with a large number of social determinants to contend with. Regardless of the adverse experiences or barriers one may be facing, it is critical to maintain a strengths-based perspective and focus interventions around building upon protective factors for the individual.