The Impact of Nonmedical Factors on Health Outcomes and How Addressing Social Determinants Can Improve Population Health Equity

Social Determinants of Health are non-medical things that affect how healthy people are. They include the conditions around people’s lives from when they are born until they grow old. These conditions are shaped by economic rules, social systems, cultural customs, and political choices. They decide if people can get important things for good health like safe homes, education, healthy food, transportation, and clean air and water.

The Centers for Disease Control and Prevention (CDC) says SDOH covers five main areas:

• Economic Stability: Income, jobs, bills, and financial help affect whether someone can pay for basic needs.
• Education Access and Quality: The level and quality of education influence how well people understand health and what jobs they can get.
• Healthcare Access and Quality: Having access to medical care and insurance affects how well people can prevent and manage diseases.
• Neighborhood and Built Environment: Safety, housing quality, transportation, and neighborhood resources impact daily life and health.
• Social and Community Context: Social support, discrimination, cultural rules, and feeling connected to others affect mental and physical health.

These areas connect with each other. For example, a person with low income might live in a place without many grocery stores that sell healthy food. This can lead to a bad diet and health problems that last a long time.

Why Social Determinants Matter More Than Medical Care Alone

Studies show things like income, education, and neighborhood affect health more than genes or medical care alone. The World Health Organization (WHO) points out that people in rich countries live 18 years longer on average than people in poor countries. This difference is mostly because of social conditions. In the U.S., there are also big differences in health between different income groups and racial or ethnic groups.

Poverty is linked to worse health and dying earlier. CDC Director Rochelle Walensky said racism is a health threat because it blocks some groups from getting good housing, education, jobs, and medical care. This makes their health worse.

This can be seen in chronic diseases. The CDC’s REACH program has been working since 1999 to reduce smoking, improve food access, encourage exercise, and help underserved communities get healthcare. This program tries to fix health problems caused by social and economic factors in minority groups.

How SDOH Create Health Inequities in the U.S.

Health inequities are unfair and avoidable differences in health among different groups of people. Social determinants are a big reason for these differences, especially in the U.S. where racism in the past and today has created unequal access to things that help people stay healthy.

For example, segregation often keeps racial and ethnic minority groups in neighborhoods with fewer resources. These areas may not have safe homes, good schools, reliable transportation, or clean surroundings. These conditions raise the risk of disease and make it harder to live healthily and get medical care on time.

The CDC says solving social determinants is key to health equity. Health equity means everyone has the chance to be as healthy as possible, no matter their social or economic background.

The Five Key Domains of SDOH and Their Consequences

Medical practice leaders should focus on these areas when planning care and community outreach:

• Economic Stability: Not having steady income or work causes stress and limits access to food and medicine. This raises the chance of long-term illness and hospital stays.
• Education Access and Quality: Low education makes it hard to understand health advice and limits job chances, which then affects income and health insurance.
• Healthcare Access and Quality: People without insurance or enough doctors often delay or skip care. This worsens diseases like high blood pressure and diabetes.
• Neighborhood and Built Environment: Unsafe areas, bad housing, and pollution link to mental health problems, asthma, and other illnesses.
• Social and Community Context: Facing discrimination, feeling isolated, or having little community support adds stress that can raise disease risks.

Public Health Approaches and Policy Efforts to Address SDOH

Healthy People 2030 is a national public health plan that prioritizes improving social determinants to reduce health differences. It calls for working together with groups outside of healthcare, like education, transportation, housing, and city planning to create environments that support health.

Fixing the root causes means making big changes. This includes pushing for higher wages, better housing rules, and improved infrastructure. For example, some places have banned menthol cigarettes to cut down smoking in vulnerable groups.

The Social Determinants Accelerator Act of 2019 helps different government agencies work together to improve social determinants. It shows that lasting progress needs work from many parts of society.

Measuring SDOH and Integrating Data for Better Health Outcomes

To improve social determinants, we need good data. The CDC encourages using different types of data—like community health numbers, environmental info, and map data—to find the areas that need the most help.

Medical practices can learn about the social situations of their patients and use data to plan support. For example, if many patients live in places with no good grocery stores, the clinic might team up with local groups to help provide better food options.

Healthcare groups can also join community coalitions. These groups bring together social services, public health, and local leaders to make plans that address social determinants in the area.

The Role of AI and Workflow Automation in Addressing SDOH

Healthcare is starting to use artificial intelligence (AI) and automated work processes more to make patient communication and resource coordination better and faster. These tools can help take care of social determinants in medical offices.

AI-Driven Front-Office Phone Automation: Some companies provide AI phone systems that can handle patient calls and appointments automatically. These systems cut down wait times and improve communication. This works well for patients who might have trouble calling because of money or time challenges.

For patients who lack transportation or cannot visit during regular hours, AI can offer 24/7 access to reminders about doctor visits, medicine refills, or vaccines. This support helps patients stick with their health plans.

Data Integration and Predictive Analytics: AI can study large sets of data from electronic health records and social services to find patients at risk due to social conditions. This helps health teams give more help, like food or ride support, where it is most needed.

Workflow Automations: Automatically collecting social history through online forms helps identify social risks without slowing down office work. Automated referrals to community programs improve connecting patients to help fast.

Impact on Medical Practice Management: For managers and IT leaders, AI tools help reduce workload, cut mistakes in communication, and improve patient engagement. They also help with reporting needs for programs that handle social determinants, which can lead to better care payments and quality.

Practical Considerations for Healthcare Leaders in the U.S.

Healthcare leaders should do these to include social determinants in their work:

• Train staff to understand social risks and how to check for them. This helps staff support patients better.
• Invest in data systems and work with public health groups to learn about local needs.
• Use AI and automation tools to improve patient communication and data management.
• Build partnerships with social service agencies to help patients with housing, food, transport, and other needs.
• Track and report on how social determinant programs are working. Use known methods like those from Healthy People 2030 to show progress and get resources.

Addressing SDOH as Part of Comprehensive Healthcare

Nonmedical things play a big role in health outcomes. This is changing how healthcare is given in the U.S. Medical administrators, owners, and IT managers all have important parts in adding social determinants into how care and operations work.

By learning about social determinants, using data to guide decisions, and applying AI communication and workflow tools, healthcare groups can better serve all kinds of patients. These steps help move toward health equity—making sure everyone has a chance to be as healthy as possible no matter their background.