When we think about what makes us healthy, our minds often go straight to medical care—doctor visits, medications, and treatments. However, the reality is that our health outcomes are shaped far more by the conditions in which we live, work, and age than by what happens in a doctor’s office. These powerful life factors are known as Social Determinants of Health (SDOH), and understanding them is crucial for achieving health equity and improving healthcare outcomes.
In an enlightening discussion, Donna Logan from Illustra Health explores how SDOH influences everything from disease management to healthcare costs, and why addressing these factors isn’t just the morally right thing to do—it’s strategically smart for healthcare organizations and communities.
What Are Social Determinants of Health?
Social Determinants of Health encompass the broad range of personal, social, economic, and environmental factors that influence individual and population health outcomes. These include:
Economic Stability
- Employment status and job security
- Income level and financial resources
- Housing affordability and stability
- Food security
Education Access and Quality
- Early childhood education and development
- Literacy and language skills
- Higher education opportunities
- Vocational training access
Health Care Access and Quality
- Access to healthcare services
- Quality of care received
- Health insurance coverage
- Provider availability and cultural competency
Neighborhood and Environment
- Housing quality and safety
- Transportation options
- Environmental conditions (air quality, water safety)
- Access to recreational facilities and healthy foods
Social and Community Context
- Social cohesion and support networks
- Civic participation opportunities
- Discrimination and social exclusion
- Community safety and violence exposure
The SDOH Impact: Beyond the Clinic Walls
Research consistently shows that SDOH account for 80-90% of health outcomes, while medical care contributes only 10-20%. This means that a person’s zip code often predicts their health outcomes more accurately than their genetic code.
For example, individuals living in areas with limited access to healthy food options, safe recreational spaces, and stable housing are more likely to develop chronic conditions like diabetes, heart disease, and obesity—regardless of the quality of medical care they receive.
Understanding Health Equity in the SDOH Context
Health equity means ensuring that everyone has a fair opportunity to attain their highest level of health. It recognizes that not everyone starts from the same place and that systemic barriers can prevent certain populations from accessing the resources they need for optimal health.
SDOH are at the heart of health inequities. When communities lack access to:
- Quality education systems
- Economic opportunities
- Safe housing
- Nutritious food
- Clean environments
- Reliable transportation
These gaps create cascading effects that compound over time, leading to significant disparities in health outcomes between different populations.
The Strategic Case for Addressing SDOH
While addressing SDOH is undoubtedly the morally right thing to do, Donna Logan emphasizes that it’s also strategically smart from a healthcare and business perspective. Here’s why:
Disease Management Impact
When underlying social determinants are addressed, chronic disease management becomes significantly more effective. For instance, helping a diabetic patient access healthy food options and safe places to exercise can be more impactful than medication adjustments alone.
Healthcare Cost Reduction
Addressing SDOH can dramatically reduce healthcare costs by preventing expensive emergency department visits, hospitalizations, and complications from poorly managed chronic conditions. Investing in housing stability or food security often costs less than treating the health consequences of housing instability or food insecurity.
Improved Clinical Outcomes
Healthcare providers see better clinical outcomes when patients’ basic needs are met. Medication adherence improves when patients can afford their prescriptions and have stable housing to store them properly. Treatment plans are more successful when patients have the transportation and social support needed to attend follow-up appointments.
Value-Based Care Success
In value-based care models where providers are accountable for patient outcomes and costs, addressing SDOH becomes essential for financial success. Organizations that ignore social determinants often struggle to achieve the quality metrics and cost targets required in these arrangements.
Measuring SDOH: ADI, SVI, and GeoHealth
Healthcare organizations increasingly use sophisticated tools to measure and understand SDOH in their communities:
Area Deprivation Index (ADI) measures socioeconomic disadvantage at the neighborhood level, incorporating factors like income, education, employment, and housing quality.
Social Vulnerability Index (SVI) assesses community vulnerability to external stresses based on socioeconomic status, household composition, race/ethnicity/language, and housing/transportation factors.
GeoHealth approaches use geographic information systems to map health outcomes alongside social, economic, and environmental factors, revealing patterns and opportunities for intervention.
These tools help healthcare organizations identify high-risk populations and target interventions where they can have the greatest impact.
Practical Applications in Healthcare Settings
Progressive healthcare organizations are finding innovative ways to address SDOH:
Screening and Assessment: Implementing SDOH screening tools during patient encounters to identify unmet social needs.
Community Partnerships: Collaborating with social service agencies, housing authorities, food banks, and community organizations to address identified needs.
Care Team Expansion: Adding social workers, community health workers, and care coordinators who can help patients navigate social services and resources.
Data Integration: Incorporating SDOH data into electronic health records and population health analytics to inform care decisions and intervention strategies.
Policy Advocacy: Supporting policies that address underlying social determinants at the community and system levels.
The ROI of Health Equity
Investing in SDOH and health equity initiatives delivers measurable returns:
- Reduced Emergency Department Usage: When basic needs are met, patients are less likely to use emergency services for non-emergency situations.
- Better Medication Adherence: Addressing transportation and financial barriers improves treatment compliance.
- Decreased Hospital Readmissions: Patients with stable housing and social support are less likely to be readmitted.
- Improved Preventive Care Utilization: When barriers are removed, patients are more likely to engage in preventive services.
Building a SDOH-Informed Healthcare System
Creating healthcare systems that effectively address SDOH requires:
Leadership Commitment: Executive leadership must prioritize health equity and SDOH as strategic imperatives, not just nice-to-have initiatives.
Cross-Sector Collaboration: Healthcare organizations must partner with housing authorities, schools, employers, and community organizations to create comprehensive solutions.
Data-Driven Approaches: Using robust data analytics to identify populations at risk and measure the impact of interventions.
Staff Training and Development: Ensuring healthcare teams understand SDOH and know how to screen for and address social needs.
Sustainable Funding Models: Developing financial strategies that support SDOH interventions, including leveraging value-based care contracts and community benefit programs.
The Future of Healthcare: SDOH-Centered Care
As healthcare continues to evolve toward value-based models focused on population health, organizations that understand and address SDOH will have significant advantages. They’ll achieve better patient outcomes, lower costs, and stronger community relationships.
The conversation around SDOH and health equity isn’t just about doing good—it’s about doing healthcare right. By recognizing that health happens everywhere, healthcare organizations can create more effective, efficient, and equitable care systems that serve all members of their communities.
Understanding and addressing Social Determinants of Health represents both a moral imperative and a strategic opportunity. As Donna Logan explains, when we ensure everyone has the support they need for their healthiest life, we create better outcomes for individuals, communities, and healthcare systems alike.
Watch the complete discussion on Social Determinants of Health and health equity:
Social Determinants of Health: Understanding SDOH and Health Equity
Discover how addressing social determinants can transform healthcare outcomes and create more equitable communities.
