Telling the Story: Social Determinants of Health, Health Literacy, Health Care Disparities

Social determinants of health (SDoH) have emerged as some of the most important factors influencing the health outcomes of people and communities worldwide. A case study is used to highlight the importance of SDoH in determining health outcomes across communities.

The World Health Organization provided one of the earlier definitions of the social determinants of health: “The conditions in which people are born, grow, live, work and age. The distribution of money, power and resources at global, national and local levels shapes these circumstances.”¹

Addressing the social determinants is an integral component of our efforts to achieve health equity. To ensure that everyone has a fair and just opportunity to be healthy, we must remove those underlying factors known to affect the health and well-being of people and communities at large.

Experts identify factors such as economic stability (employment, income), neighborhood/physical environment (housing, transportation, zip code), education (level of education, vocational training), food (access to nutritious foods), community and social context (support network, discrimination), and health care (access to quality care, cultural sensitivity) as some of the most influential drivers shaping health outcomes (life expectancy, health outcomes). These social, economic and physical environmental factors may contribute as much as 80% to health outcomes. Traditional clinical care contributes the remaining 20%.^2,3

Although health care expenditures continue to rise in the United States, the United States experiences some of the poorest health outcomes compared with other developed countries.⁴ As a result, health care systems, insurers, and others are looking to address the social determinants of health as a means to improve health outcomes and decrease health care costs.

Patient navigators are key to any efforts devoted toward reducing health disparities and ultimately achieving health equity. By nature of their close proximity to patients and families, patient navigators are encouraged to assess for the influence of the determinants of health on cancer outcomes. Navigators are well positioned to provide excellent navigation services that address the determinants of heath and advocate for programs and policies that can mitigate the unfavorable influence of the social determinants of health on cancer care and cancer outcomes.

References

1. World Health Organization. Social Determinants of Health. Accessed September 12, 2020. https://www.who.int/gender-equity-rights/understanding/sdh-definition/en/

2. University of Wisconsin Population Health Institute. County health rankings model. Accessed September 12, 2020. https://www.countyhea,lthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model

3. Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC. Understanding and addressing the social determinants of health to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA Cancer J Clin. 2020;70(1):31-46. doi:10.3322/caac.21586

4. Shi L, Singh D. Essentials of the Health Care System. Jones and Bartlett Learning; 2018.