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A Critical Focus: The Social Determinants of Health

Dahlgren, G. & Whitehead, M. 1991. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies.

Figure 1: Social Determinants of Health

The World Health Organization describes social determinants as “the conditions in which people are born, grow, live, work, and age. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels.” That is to say, not only do our individual social circumstances play into our health, but so do larger systems – sometimes on a global scale – over the course of our entire lifespans.

When I first heard about the social determinants of health, it was a foreign theory to me but one that seemed to fit the concepts I was already very much aware of. Of course our social circumstances impact our health; how could they not?

Studying public health in the United Kingdom and working for their National Health Service (NHS) gave me a glimpse into how other health systems prioritize and address social factors as indicators of health. Now working for America’s Essential Hospitals, I am seeing essential hospitals take the lead in a system where these topics are not as prominent in political discussion or care delivery.

The Dahlgren and Whitehead model (see Figure 1) offers a realistic picture of the different layers of the social determinants of health. These determinants encompass most of the social complexities challenging essential hospital patient populations.

If left unaddressed, these challenges can negate medical treatment. Essential providers, for example, are left to solve the problems of how to provide diabetes care to a patient who doesn’t have a fridge to store insulin. Or how to prescribe healthy eating when patients have no access to fresh produce or can barely afford to feed themselves and their family.

In my time at America’s Essential Hospitals, I have had the privilege of witnessing our members in action. I have spoken with providers and I have spoken with patients. All agree that taking the time to address these social factors makes a world of difference in effectively providing medical care.

Strategizing different ways to meet patients’ social needs is exactly the type of work that is distinguishing essential hospitals as national frontrunners in addressing the social determinants of health.

Securing patients’ housing, providing access to nutritional food, connecting patients with employment opportunities, and beautifying and supporting communities are all examples of non-traditional care delivery that, in addition to appropriate medical care, is resulting in improved patient outcomes.

As we progress in health care reform, social determinants of health will continue to be highlighted throughout policy and national movements. Thus, more of our web content will address these important issues and the work of essential hospitals as frontrunners in this type of care as we move into a new era of health care delivery.


About the Author

Janelle Schrag is a senior program analyst with America's Essential Hospitals.

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