Often Forgotten Structural Determinants of Health

back pain and an old bed is a structural determinants of health exampleStructural determinants of health (SDOH) include a wide range of socioeconomic status, physical environment, education, social support networks, employment, and even health care equity. Social determinants of health refer to individuals’ circumstances that affect their health and overall well being.

They may include socioeconomic, cultural, and political factors and how easily a person can access education, healthcare services, nutritious food, and a safe place to live.

The World Health Organization (WHO) describes social determinants of health as “the actual conditions in which we’re born, grow, work, live, and age. They also include the wider set of systems and forces that shape our daily lives.”

Structural and social determinants of health are a wide range of factors found across all aspects of society. They’re separate from health care or even a person’s lifestyle options.

The National Academy of Medicine discovered that medical care alone accounted for around 10–20% of the contributors to people’s health outcomes.

On the contrary, numerous social determinants of health have a much more significant role in affecting a person’s health. They make up to 80–90% of the overall contributing factors.

What Are Structural Determinants of Health?

People who work in the health care industry tend to assume that every health care consumer cares about the same things they do. These may include getting and maintaining proper health by being a well-educated patient, managing chronic medical conditions, participating in yearly well visits, perform medication reconciliations and taking medications.

Nonetheless, it is worth acknowledging that such things are not usually on the minds of the typical health care consumer, particularly those with socioeconomic barriers to care. Getting health care might be one of numerous competing priorities that often goes on the back burner compared to a relatively long list of more valuable things such as finding a job, paying the rent, or simply scheduling an appointment.

In most cases, resources to deal with socioeconomic challenges fall outside the scope of providers or the benefit structure of health plans. That said, one might argue that you can’t effectively care for anyone when neglecting life factors that may have an immense impact on community health.

Health care organizations must direct their efforts and resources toward these problems, dealing with issues of social inequities, and eliminating barriers that adversely impact the health disparities and quality of their members. Now, the real question is: how can they do this when this kind of prevention doesn’t come on a claim?

Determining Social Determinants

Every health care organization needs to outweigh claims data and get conversations with consumers to determine scenarios beyond the models by:

  • Asking about their access to various necessities, e.g., shelter, housing, mobile clinics, and even access to transit to reach their doctor’s appointments.
  • Creating strategies to evaluate and addressing social and structural determinants of health and get an open and direct dialogue with members.
  • Evaluate physical and mental health changes and their housing stability over a certain period. They can also assess their caretaker stress, financial worries, and perceived ability to deal with problems and seek assistance when required.
  • Actively listening to their feedback and connecting them with community resources and plans that can help them beat barriers to care.

This last strategy may come in delivering meals, a ride to an appointment, or professional care services. These little fixes can often have huge impacts on a person.

For instance, a specific member was flagged for transfer to a professional care manager who found out that the member was struggling with chronic back pain worsened by an old mattress. They partnered with a local nonprofit that took the member and assisted him in getting a new bed in a week.

If you survey health plan members through interactive voice response technology, you will discover that it tends to influence them in many ways. Those who have concerns about general necessities (i.e., food, shelter, security) will be much more likely to report having poor health, more likely to have high emotional stress, and more likely to have their health adversely affecting their work office.

When it comes to low-income populations, dual-eligible people for Medicare and Medicaid have proven to have the most concerns regarding life necessities. Medicaid enrollees and lastly Marketplace follow them.

Examples of structural determinants of health can be classified into five major groups:

  1. Healthcare: This category encompasses an individual’s access to healthcare and its overall quality. Some important factors are access to primary healthcare, health literacy, public health insurance coverage


  1. Education: This group closely examines the connection between an individual’s access to education and overall mental health. Some of these are childhood development, secondary education, higher education, language, and literacy


  1. Economic stability: It refers to the association between an individual’s finances and health equity. Some factors include employment, poverty, housing stability, and food.


  1. Social & Community: This category revolves around the fundamental ways a person lives, plays, works, and learns and how this impacts the person’s health. Factors entail: Discrimination, civic participation, the office, and incarceration


  1. Neighborhood: This category considers where people are born including an individual’s housing and environment and the essential role in the person’s health. Examples of factors are transportation, accommodation, access to healthy foods, crime and violence, water quality

The factors in each category are interwoven and mostly linked to each other. And all these factors can also contribute to community health, quality of life, and overall well being.

How Do Structural Determinants of Health Impact Well Being?

It’s worth noting that health inequities aren’t about making bad choices, not accessing medical assistance, or even bad genes. Health inequities often come from avoidable structural issues in communities. Generally, these social determinants of health may lead to health inequities and disparities.

For instance, if people cannot access grocery stores offering healthy foods, they’re less likely to get good nutrition. It could enhance their risk of medical problems such as obesity, heart problems, and prevention of diabetes.

The local economy plays a huge role in job opportunities, which influences income, food choices, and housing. These could then impact the public health and overall well being of an entire family.

Promoting healthy choices or health promotion won’t remove these barriers. Instead, every national government sector, such as education, and housing, needs to come together and create fair policies or systems such that the public can achieve equivalent outcomes.

In general, varying inputs for different groups might be needed to get equivalent outcomes.

Person shopping for fruits and vegetables in grocery store

What Are Some of the Risk Factors?

Disability status and age play a significant role in structural determinants of health, especially when combined with income. Generally, dual-eligible members with lack of necessities have an increased likelihood than Medicaid enrollees to claim that emotional and physical health issues affect “productivity,” or their capability to perform their job  or when caring for other people.

Additionally, having concerns about necessities implies that members have a reduced chance to be active participants in regulating their health. With Marketplace members, people had a reduced chance to close preventive care gaps such as cervical and breast cancer screenings, compared to people without concerns.

The Time For Action

It’s worth using numerous opportunities to collect structural determinants of health feedback across their tenure with a proper plan and track any changes over time. Give immediate help to those who report problems for which resources are available. Next, analyze health behaviors while taking note of responses and interventions to gather lessons learned and review programs.

Early screening and recognition via interactive conversations is a common method of ensuring low-income populations are linked to effective interventions to manage the underlying factors affecting health.

What Is BioScan?

BioScan gathers your body’s information using Galvanic Skin Response (GSR). It’s worth noting that no blood draw is required, and there’s no need for a clinical laboratory. Typically, an electrode is placed in your patient’s hand, and within minutes, results are displayed graphically via test protocols on the screen.

You may want to identify, for example, trace elements, minerals, vitamins, heavy metals, or hormones. It’s worth noting that BioScan measurements are primarily for active health care. Although BioScan can’t replace a blood analysis test, it does offer additional information and conveniently portable for reaching patients with limited transportation options.

Conclusiondiverse people standing together

The conditions into which we’re born and live our lives have an immense impact on our health. Where people are born, go to school, work, and live is what professionals refer to as structural determinants of health.

Such factors influence an individual’s opportunities to eat a nutritious diet, live in a toxin-free environment, have a good education, access healthcare, etc. The WHO and national governmental organizations constantly focus on addressing SDOH and improving health disparities for every citizen to enable equal access to better healthcare.



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