There is growing traction in the medical field to Screening for social determinants of health within clinical care. There are a number of tools to do so, including some that can be uploaded into electronic health records and others that are administered by clinical or nonclinical staff.
Some champions of this approach question whether screening can do much to address social determinants, which are fundamentally political and structural in nature.
Social and Economic Status
The non-medical factors that influence health outcomes are referred to as social determinants of health. They fall into five categories: economic stability, health care access and quality, education, neighborhood and environment and social and community context.
Socioeconomic status (SES) is the social standing or class a person is a member of based on income, occupation and education. It varies across cultures and includes membership in groups based on race, religion, national origin and region, as well as social class determined by income and wealth.
Those with lower SES have greater challenges meeting basic needs such as food, housing and transportation. They also face a higher risk for stress, which can have negative impacts on their physical and mental health over time. This is because of the impact of a variety of environmental and economic factors, including low wages, inadequate or unstable employment, high crime rates and lack of community services. These factors can also lead to the perpetuation of health inequities over generations.
Environment
A range of environmental factors affect health and well-being, including the quality and availability of the physical environment, such as housing and access to services. This includes food, water and transportation systems. Having easy access to health care is another important factor in good health, but many people have difficulty getting the help they need. This may include being unable to afford healthcare or having to travel long distances to receive it. In rural and remote locations, for example, people have less access to doctors and other specialists, such as nutritionists and physiotherapists, and may also have difficulty accessing health technology such as kidney dialysis machines.
Many studies on the links between the environment and health have used aggregate summaries of area socioeconomic or race/ethnic composition or residential segregation as proxies for various environmental attributes, but these measures can be difficult to interpret and may not be able to identify individual-level impacts over time. UNDP has developed an easy-to-use screening tool that allows development practitioners to incorporate SEEDs of health and dimensions of equity into routine project planning and implementation.
Stress
Many people feel stressed about their job, money or family. This can cause a stress response that triggers the body’s “fight or flight” hormones and increases heart and breathing rates. When this happens over time, it can be unhealthy for your mind and body.
A person’s neighborhood can impact his or her health. For example, some neighborhoods have lots of places to buy healthy food, while others lack these options. Neighborhoods are also influenced by housing, economic and social policies.
Some social determinants of health are harmful, while others can be beneficial. For example, an unsustainable transportation system that relies on automobiles and highways can harm people’s health by contributing to obesity and pollution, while a transport system that focuses on public transportation and walking and biking can benefit health by reducing traffic and air pollution.
Health Care
Structural determinants are those factors that shape the quality of living conditions in a community. These are the larger forces — often political and economic — that influence the availability of resources like health care, education, employment, and housing and that lead to disparities in income, social support, and opportunity across neighborhoods and communities.
Screening tools that help frontline clinicians identify these factors are gaining traction. There is also increasing momentum for integrating this approach in clinical practice workflows, and for developing more comprehensive interventions at both the patient-level and community-level.
However, there are also champions in the field who question whether screening is the right intervention at this time. They argue that in order to impact the structural determinants, it is necessary to address the overall political and economic conditions that shape them. This will require broad intersectoral action and whole-of-government approaches, not just conversations in exam rooms.
