Social Determinants

Physical and mental health are shaped by more than biology. A person’s location, income, education, and support network all affect how well and how long they live. In fact, these factors may have a stronger impact on health than clinical care. These real-world conditions, known as social determinants of health (SDOH), shape how people feel, function, and live day to day.

What are Social Determinants of Health?

SDOH are made up of a broad range of circumstances and environments that influence how people live, work, learn, and age. These non-medical factors extend far beyond doctor visits and medications, shaping health outcomes in profound ways throughout a person’s life.

SDOH comprise five key domains ^[1]: 

• Economic Stability 
• Education Access and Quality
• Healthcare Access and Quality
• Neighborhood and Built Environment
• Social and Community Context 

Each domain plays a distinct role in health outcomes. For example, economic stability affects access to nutritious food and safe housing, while education influences health literacy and career opportunities. Meanwhile, the neighborhood environment impacts exposure to pollution and access to green spaces, and social connections provide emotional support during challenging times. 

While each domain covers specific factors, it doesn’t exist in isolation and instead interacts with other domains in complex ways. For example, a person’s zip code can determine their access to quality schools, which affects their job prospects, which in turn influences their ability to afford healthcare and maintain good health.

Together, these interconnected forces create a ripple effect that can either support long-term well-being or contribute to cycles of poor health. By examining the full picture, including not just medical symptoms but the conditions that shape daily life, it becomes easier to understand what truly drives health outcomes.

Why are SDOH Important?

Health doesn’t start in the exam room or therapist’s office. It starts with access to safe housing, clean air, stable employment, reliable transportation, and supportive relationships. According to the World Health Organization (WHO), these conditions of daily life combined with the distribution of money, power, and resources can account for wide differences in health outcomes across populations ^[2]. 

To illustrate the impact of SDOH, the WHO offers the following data points, which pertain to financial factors alone ^[2]: 

• Life Expectancy: Life expectancy varies drastically between low- and high-income nations, with those in the high-income locations living an average of 18 years longer. 
• Premature Deaths: In 2016, low- and middle-income nations bore the brunt of premature deaths from non-communicable diseases, accounting for most of the 15 million lives lost.
• Disease Disparities: Across all global regions, income-related disparities in diseases like cancer have widened, with wealthier populations experiencing better outcomes than poorer ones.

While these stats are limited to the economic realities of SDOH, research shows that poor living conditions, economic hardship, and social disadvantage can all increase the risk of both physical and mental illness. For example, limited access to education and employment can lead to higher stress levels, reduced access to care, and increased risk of depression or chronic disease ^[3]. 

These patterns reveal how social conditions, not just biology or behavior, play a powerful role in shaping health outcomes. Addressing these root causes is key to building healthier, more equitable communities.

How Money Influences Health

Economic stability, one of the core SDOH, refers to access to steady income, employment, and resources needed to meet basic needs. Minus financial stability, physical and mental health often suffer, as finances can shape nearly every part of a person’s health journey.

When housing eats up more than 30% of a person’s income, for example, it leaves little room for essentials like healthy meals, necessary medications, or transportation. Additionally, families under financial strain are often forced to move homes frequently, which is a disruption linked to higher rates of chronic illness in children and reduced access to steady health care and schooling ^[4]. Plus, when people are focused on daily survival, preventive care often takes a backseat. 

And for many, the tough choices are relentless: Cover the cost of insulin or transportation to work? Purchase healthy food or pay the electric bill? These impossible trade-offs add stress that chips away at overall health and stability. 

The Power of Relationships and Community 

Supportive relationships can be just as important to health as nutritious food or clean water. The people someone interacts with, including family, friends, coworkers, and neighbors, shape how they cope with stress, navigate challenges, and stay connected to a sense of purpose. This domain of social determinants, known as social and community context, highlights how connection, inclusion, and trust affect both physical and mental well-being. 

While personal relationships are important, they’re shaped by more than personal connections; they’re also influenced by larger systems. Civic engagement, access to safe public spaces, experiences with discrimination, and involvement with the justice system can all shape a person’s place in their community. For example, people with a history of incarceration may face stigma or barriers to employment and housing, which can deepen isolation and impact health long after release ^[5]. 

Along these same lines, structural discrimination, which can be embedded in laws, policies, and institutional practices, can take a heavy toll on health. When certain groups face limited access to housing, health care, or educational opportunities, the resulting stress can contribute to chronic mental health issues ^[4]. 

Social cohesion, or the feeling of belonging within a community, also plays a key role. When people feel included and valued, they’re more likely to participate in local events, seek care when needed, and support others in return. 

How Education Impacts Health

Educational attainment is a powerful predictor of health outcomes throughout life. That’s because higher levels of education are associated with healthier behaviors, increased use of preventive care, and longer life expectancy. What’s more, education affects how people understand health information and make decisions about treatment. Plus, those with more schooling are also more likely to secure jobs with stable income, health insurance, and paid sick leave, all of which support better health over time ^[4]. 

However, education’s benefits extend far beyond knowledge acquisition. After all, schools provide structured environments where children and young adults develop social skills, establish healthy routines, and learn stress management techniques. These settings also offer opportunities for physical activity, health screenings, and mental health support.

Plus, many schools serve as community hubs, connecting families to essential resources and services. Those who aren’t involved in or don’t have access to quality schools miss out on these important benefits ^[6]. Over time, these educational advantages shape not only job opportunities but also emotional resilience and long-term health. 

Importance of Accessible Healthcare

Access to primary health care, which is a consistent provider of disease detection services, treatment, and prevention, is vital for maintaining good health. Specifically, regular primary care reduces deaths from cancer, heart disease, and stroke by giving people opportunities to manage their health proactively. When barriers like insufficient insurance coverage or a shortage of providers limit access, health outcomes suffer ^[4]. 

Despite these benefits, roughly one in 10 Americans lacks health insurance, reducing their chances of having a primary care provider or affording needed care. Plus, even when people have insurance, they may miss recommended services like cancer screenings due to lack of transportation or distance from providers ^[7]. 

Closely tied to primary care access is health literacy, which is key to empowering people to safeguard their own well-being. When people grasp health risks and prevention strategies, such as avoiding sexually transmitted infections, they can take meaningful steps to protect themselves. In fact, low health literacy is linked to higher hospitalization rates, fewer preventive screenings like mammograms and flu vaccines, and increased mortality among older adults ^[4]. 

Impact of Location and Housing

Where people live can significantly influence their physical and mental well-being. From access to clean air and water to the safety of streets and homes, the built environment plays a major role in shaping health outcomes. Yet, many U.S. neighborhoods face environmental and structural challenges. Exposure to pollutants, secondhand smoke, or loud noise at work adds to these risks ^[8]. Plus, poor housing conditions, such as moldy environments, faulty plumbing, or inadequate ventilation, can lead to asthma, respiratory issues, and carbon monoxide poisoning ^[4]. 

Food access is another critical concern. In areas known as food deserts, residents often struggle to find affordable, nutritious options. This puts them at greater risk for obesity, high blood pressure, and diabetes. These same neighborhoods may also be prone to safety concerns.

High rates of crime and violence can lead to stress, anxiety, depression, and reduced physical activity if people feel unsafe going outside. One study even linked neighborhood fear to increased obesity levels ^[4]. Together, these environmental and structural factors create conditions that can either support health or deepen existing health disparities.

How to Advocate for One’s Health

Understanding how factors like income, relationships, education, healthcare, and housing shape well-being is only part of the picture. The next step is action, namely finding ways to speak up for personal needs and push for changes that support healthier lives and communities.

Health advocacy starts with knowing personal rights and feeling empowered to ask questions, seek support, and make informed decisions. That might mean preparing for medical appointments with a list of concerns, asking for a second opinion, or requesting accommodations like an interpreter or disability access. However, it also includes learning how to navigate insurance options or treatment plans.

Advocating for health doesn’t stop at the personal level though. It often means joining forces with others through support groups, local initiatives, or community coalitions to demand better services, safer environments, or more equitable policies. Whether it’s pushing for mental health programs in schools or fighting for access to fresh food, these efforts drive real change.

Because social determinants of health impact everything from doctor visits to daily routines, systemic solutions matter too. Contacting elected officials, voting with health equity in mind, or supporting nonprofits can amplify each voice and help shift the larger structures that shape well-being. After all, advocacy is about agency. It’s the power to influence a person’s care and environment, and the systems that affect both, turning awareness into action and obstacles into opportunities.

SDOH and Lasting Change

Health is influenced by more than genetics or clinical care. It’s shaped by a wide range of social and environmental factors, including education, income, housing quality, neighborhood safety, and access to medical services. These social determinants play a central role in determining how long people live, how well they feel, and what opportunities they have to thrive.

As such, improving health outcomes requires more than treating illness. It also means addressing the conditions that give rise to poor health in the first place. Communities benefit when policies support access to nutritious food, stable housing, safe environments, and quality education.

By strengthening these foundational elements, societies can cultivate resilience, reduce disparities, and promote overall well-being. After all, health is not created in isolation but is deeply connected to the systems and structures that surround people  throughout their lives. As such, true health equity begins by transforming the environments that make health possible.