SDOH: Impacting healthcare from outside the system.

By Ben Keeton

The focus of efforts to improve health in the United States largely revolve around the traditional healthcare system, with an increasing focus on providing access to care through health insurance and incentivizing consumers to make better healthcare decisions. Over the past five years, policy efforts have primarily focused on ways to increase access to health coverage and making significant changes to the healthcare system

However, according to the Kaiser Family Foundation, increasing access to healthcare and transforming the healthcare delivery system are important, research demonstrates that improving population health and achieving health equity also will require broader approaches that address social, economic and environmental factors that influence health.

Social determinants have a significant impact on health outcomes. Social determinants of health are the structural determinants and conditions in which people are born, grow, live, work and age. They include factors like socioeconomic status, education, the physical environment, employment, social support networks, as well as access to healthcare. According to the American Journal for Public Health, researchers found that social factors, including education, racial segregation, social supports and poverty accounted for over a third of total deaths in the United States in a year.

How It Translates

Studies have shown that the likelihood of premature death increases as income goes down. Similarly, lower education levels are directly correlated with lower income, higher likelihood of smoking and shorter life expectancy. Children born to parents who have not completed high school are more likely to live in an environment that poses barriers to health. Their neighborhoods are more likely to be unsafe, have exposed garbage or litter, and have poor or dilapidated housing and vandalism. There is also growing evidence demonstrating that stress negatively impacts health for children and adults across the lifespan.

The Quarterly Journal of Economics reports a study showing that where a child grows up impacts his or her future economic opportunities as an adult also suggests that the environment in which some individual lives may have multi-generational impacts.

In Kentucky

Living in rural parts of our country can bring added challenges. In Kentucky, rural residents experience many inequities compared to the nation or state as a whole. Often rural residents have fewer individual resources and, on average, are poorer and less educated.

According to Poverty Overview from the USDA Economic Research Service, many rural residents face barriers related to access to housing, transportation, and foods that are safe, healthy, and affordable. These barriers can impact all residents, though they are particularly problematic for those already struggling financially.

As Kentucky looks for ways to significantly improve the health of its citizens, it is important to continue to look at the entire healthcare ecosystem. This issue of Medical News will examine several factors that impact a community health including education and workforce development, food security and access to transportation. We hope this is the beginning of a much larger conversation and invite the members of the healthcare community to be a part of the conversation.

Share Your Thoughts: How is your organization working to address SDOHs and health disparity within our state? Tag us on Twitter @kymedicalnews or email me at

Health Disparities

A particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

-US Department of Health and Human Services. Healthy People 2020

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Ben Keeton

Publisher at Medical News
Ben is the publisher of Medical News and focuses on the business of healthcare in Kentucky.
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