Social Determinants of Health
An integral part of health care delivery is understanding the social and environmental factors of patients’ lives outside of the medical care system, including where they are born, grow, live, work, and age.
An integral part of health care delivery is understanding the social and environmental factors of patients’ lives outside of the medical care system, including where they are born, grow, live, work, and age.1
Social determinants of health (SDOH) and health services encompass multiple factors—
- Social and economic factors (e.g., race/ethnicity, gender/sex, education, employment/occupation, income/poverty, family and social support, community safety).
- Physical infrastructure of the community (e.g., housing, transportation, food access, parks, air and water quality, social services).
- Health, health behaviors, and culture of health care in the community (e.g., view of health care and prevention, health promotion initiatives, health care laws).
- Clinical care and healthcare delivery (e.g., access to care, quality of care, demand and supply side of healthcare)
The National Academy of Medicine2 identifies key factors in understanding social determinants of health in health care—
- As a determinant of health, medical care is insufficient for ensuring better health outcomes.
- SDOH are influenced by policies and programs, and associated with better health outcomes.
- New payment models are prompting interest in the SDOH.
- Frameworks for integrating SDOH are emerging.
- Experiments are occurring at the local and Federal level.
AHRQ is actively engaged in assisting clinicians, health system leaders, policymakers and researchers in finding opportunities to improve health care through a better understanding of SDOH of patients and communities.
AHRQ offers data resources, tools, and research related to SDOH, as well as funding opportunities to explore various areas of influence.
- Contextual Factors: The Importance of Considering and Reporting on Context in Research on the Patient-Centered Medical Home
This brief focuses on the importance of considering and reporting contextual factors in studies of patient-centered medical home (PCMH) models.
- NHQR/NHDR Dissemination of Information on State Data-Driven Strategic Efforts to Reduce Health Disparities
This summary of the activities and accomplishments of NHQR/NHDR Dissemination of Information on State Data-Driven Strategic Efforts to Reduce Health Disparities summarizes activities, achievements, and assessment of impact.
- Using Geographic Information to Target Health Disparities: State Experience
This brief describes how two States have analyzed race and ethnicity data and targeted interventions to specific geographic locations.
- Integrating social determinants of health into primary care clinical and informational workflow during care transitions
- How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview
- Medically Underserved Populations
- Healthcare Cost and Utilization Project (HCUP)
The Healthcare Cost and Utilization Project (HCUP) includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to health care programs, and outcomes of treatments at the national, State, and local market levels. The foundation of the HCUP is a Federal-State-Industry partnership that brings together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of encounter-level health care data (HCUP Partners).
- Medical Expenditure Panel Survey (MEPS)
The Medical Expenditure Panel Survey (MEPS), which began in 1996, is a set of large-scale surveys of families and individuals, their medical providers (doctors, hospitals, pharmacies, etc.), and employers across the United States. MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, as well as data on the cost, scope, and breadth of health insurance held by and available to U.S. workers.
HCUPnet is a free, on-line query system based on data from the Healthcare Cost and Utilization Project (HCUP). The system provides health care statistics and information for hospital inpatient, emergency department, and ambulatory settings, as well as population-based health care data on counties. HCUPnet can be used to examine national, State, and county-level estimates of hospital utilization by SDOH factors (i.e., patient demographics, urban/rural, community level income, expected payer).
- HCUP Fast Stats
HCUP Fast Stats provides easy access to the latest HCUP-based statistics for health care information topics. HCUP Fast Stats uses visual statistical displays in stand-alone graphs, trend figures, or simple tables to convey complex information at a glance. HCUP Fast Stats can be used to examine national and State estimates of hospitalization utilization over time by SDOH (i.e., patient demographics, urban/rural, community level income, expected payer).
- National Healthcare Quality and Disparities Reports
The National Healthcare Quality and Disparities Report presents trends for measures related to access to care, affordable care, care coordination, effective treatment, healthy living, patient safety, and person-centered care.
Use the MEPSnet tools to search for or generate specific estimates of interest for either the MEPS-HC or MEPS-IC.
- The Root of the Problem: Americaâs Social Determinants of Health
Alex M. Azar II, Hatch Foundation for Civility and Solutions, November 14, 2018, Washington, D.C.
- AHRQâs Commitment to Meeting Unmet Needs in the Healthcare System
Blog by Gopal Khanna, M.B.A., February 1, 2019
- AHRQ Keeps Working To Reduce Health Disparities
Blog by Francis Chesley, M.D., April 24, 2018
- From Hype to Reality: How Artificial Intelligence Can Transform Health and Healthcare
Blog by Teresa Zaya CabÃ¡n, Kevin J. Chaney, Chris Dymek, and Michael Painter, January 17, 2018
1. WHO (World Health Organization). 2019. Social Determinants of Health. Available at: https://www.who.int/social_determinants/sdh_definition/en/
2. Magnan S. Social Determinants of Health 101 for Health Care: Five plus Five. National Academy of Medicine Discussion Paper. October 9, 2017. Available at: https://nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/
Related AHRQ Resources
External Data Sources
Data sources from several other Federal agencies: