The Epidemiology of Social Determinants of Health

Social determinants of health (SDoH) encompass various non-medical factors, such as socio-economic status, education, living conditions, and access to healthcare. A range of studies have highlighted the role of SDoH on chronic diseases. They can impact SDoH directly and indirectly. For example, Tang (2013) identified income, education, and job nature as key determinants in China. Hill (2013) discussing the influence of physical and social environments, such as low income and poor living conditions, on diabetes in the US. Research to date collectively underscore the need for a holistic approach to addressing chronic diseases, one that takes into account the broader social and economic factors that contribute to their prevalence and impact. The Healthy People 2030 framework provides a valuable lens for deconstructing this intricate web. It identifies five key domains as the foundational pillars of SDoH: 1. Economic Stability: Income disparities, food insecurity, and inadequate housing are potent stressors, disrupting biological pathways and increasing susceptibility to chronic diseases. 2. Education Access and Quality: Educational attainment acts as a potent buffer against health inequities. Higher levels of education correlate with improved health literacy, healthier lifestyle choices, and greater access to preventive healthcare services. 3. Social and Community Context: The presence of strong social networks serves as a protective shield, fostering healthy behaviors and mitigating the impact of chronic stress. 4. Neighbourhood and Built Environment: The physical environment we inhabit plays a crucial role in shaping health choices and opportunities. Access to green spaces, safe pedestrian infrastructure, and healthy food options facilitates healthy behaviors. 5. Health Care Access and Quality: The healthcare system itself acts as a critical determinant of health outcomes. Equitable access to quality healthcare services plays a fundamental role in disease prevention, early diagnosis, and effective management of chronic conditions. Possible epidemiological projects include: (1) Use of linked data to better understand SDoH A range of studies have highlighted the importance of linked data in understanding the social determinants of health and addressing health disparities. Young (2018) emphasizes the need for international data linkage to identify the determinants of health inequalities in socially excluded groups. Sadana (2011) underscores the role of valid, public domain data in this effort, particularly in monitoring social determinants and health outcomes. Gottlieb (2013) and Galea (2020) both advocate for the collection and application of social determinants data in healthcare settings, with Gottlieb proposing a framework for interventions at different levels and Galea discussing the potential of data science in this field. (2) Examining the influence of SDoH on chronic disease For example, there is a growing body of research highlight the significant impact of SDOH on cardiovascular disease (CVD) (e.g. Jilani 2021, Mannoh 2021, Powell-Wiley 2022, Teshale 2023) and dementia (e.g. Majoka 2021, Liu 2021). These determinants, including economic stability, education, healthcare access, and neighbourhood characteristics, are linked to a higher burden of CVD risk factors and poorer outcomes (Jilani 2021). Lower socioeconomic status and education, as well as manual labor, have been associated with a higher incidence of Alzheimer's disease and related dementias (Majoka 2021).They also intersect and manifest as persistent inequalities in CVD, contributing to its morbidity and mortality (Mannoh 2021). The COVID-19 pandemic and the social justice movement have further highlighted these health inequities (Powell-Wiley 2022). Despite the need for more comprehensive evidence, it is clear that addressing SDOH is crucial in reducing the burden of CVD (Teshale 2023) and other chronic disease. (3) Evaluating solutions to SDoH Health systems can play a more active role in addressing SDoH by revising policies to support direct interventions (Chaiyachati, 2016). This approach should be complemented by a focus on health behaviors, which are influenced by societal factors and can be modeled to enhance understanding (Short, 2015). To reduce health inequalities, action on the social determinants of health is crucial, including addressing poverty and improving living and working conditions (Gross). One possible solution is social prescribing. Social prescribing involves a trusted referrer connecting a person to a link worker, who acts as a resource while the individual creates their own personalised plan, identifying opportunities and avenues for enrichment to enhance their quality of life. See: ASPIRE Australian Social Prescribing Institute of Research and Education (ASPIRE) https://www.creatingopportunitiestogether.com.au/