Social determinants of health Study Guide

📖 Core Concepts Social Determinants of Health (SDH) – Non‑biological factors (e.g., income, education, neighborhood) that shape health and quality of life. WHO view – Health is molded by circumstances of birth, growth, living, work, aging, and the systems that address illness. Six core SDH categories – Economic stability, Education, Social & community context, Race & gender, Health‑care access, Built environment. Impact magnitude – > 50 % of an individual’s health outcomes are driven by SDH, outpacing clinical care or genetics. Life‑course perspective – SDH operate from pre‑birth through adulthood; early disadvantages can set lifelong health trajectories (latent, pathway, cumulative effects). 📌 Must Remember Mortality & education – < HS education → > 2× higher mortality than higher‑educated peers. Income inequality – Higher societal income gaps → higher overall mortality. Economic stability → health‑care access – Financial security improves service use, lifestyle, and living conditions. Neighborhood food deserts – Lack of affordable healthy foods ↑ cholesterol, heart disease, diabetes. Chronic stress pathway – Persistent stress → ↑ cortisol → inflammation, immune dysregulation, allostatic load. Device & algorithm bias – Pulse oximeters overestimate O₂ in darker skin; race‑adjusted spirometry and kidney‑function algorithms lack scientific justification. Clustering – One adverse SDH often co‑occurs with others, magnifying risk. Good job definition – Safe, adequate pay/benefits, work‑life balance, security, employee voice, skill building. 🔄 Key Processes Screen & Document SDH in Clinical Visits Ask about housing, food security, income, transportation, education, discrimination. Record responses in EMR to trigger referrals. Link to Social Services Community health worker (CHW) coordinates patient‑provider plan → connects to cash‑transfer, nutrition, housing programs. Life‑Course Intervention Pathway Early childhood: nutrition programs → reduced low‑birth‑weight & better development. School age: class‑size reduction, literacy support → higher graduation → better employment. Adulthood: job‑training, safe‑work policies → reduced exposure, improved income. Bias Auditing for Technology Validate device/algorithm performance across race, gender, skin tone. Adjust or replace biased tools; document changes. 🔍 Key Comparisons Economic stability vs. Education Economic: Directly enables health‑care access, reduces financial stress. Education: Indirectly boosts stability by increasing earning potential and health literacy. Rural vs. Urban Health‑Care Access Rural: Fewer hospitals/providers → longer travel, delayed care. Urban: More facilities but may face insurance complexity and provider shortages in underserved neighborhoods. Device bias vs. Algorithm bias Device: Physical measurement error (e.g., pulse oximeter). Algorithm: Data‑driven decision error (e.g., race‑adjusted eGFR). ⚠️ Common Misunderstandings “Clinical care is the biggest health driver.” – Evidence shows SDH account for > 50 % of outcomes. “Higher income automatically eliminates health risk.” – Relative position and chronic stress still matter. “Race‑based corrections are scientifically solid.” – Many (spirometry, eGFR) lack justification and embed bias. “Education alone cures health inequities.” – Without material resources, knowledge may not translate into healthier behavior. 🧠 Mental Models / Intuition Social Gradient – Health improves stepwise with each rise in socioeconomic status; think of a ladder, not a binary rich/poor divide. Allostatic Load – Repeated stress hormones are “wear‑and‑tear” on the body; visualise a rusted metal beam weakening over time. Clustering Effect – One adverse SDH → “dominoes” that bring in others (e.g., low income → food insecurity → poor nutrition → chronic disease). 🚩 Exceptions & Edge Cases Transgender & non‑binary individuals – Face higher poverty, mental‑health challenges, and distinct health‑care barriers despite gender category. Race‑adjusted spirometry – Not evidence‑based; may under‑diagnose lung disease in Black patients. High‑income but high‑stress occupations – Good pay does not fully offset chronic psychosocial stress. 📍 When to Use Which Screening tool vs. full social‑needs assessment – Use quick 5‑item screen for busy visits; employ comprehensive assessment when CHW support is available. Cash transfer vs. education intervention – Choose cash transfers for immediate food/medication access; opt for education programs for long‑term socioeconomic uplift. Universal design vs. targeted accommodations – Apply universal design in all health‑care facilities to pre‑empt disability barriers; add specific aids (e.g., sign language interpreters) when needed. 👀 Patterns to Recognize Multiple SDH in a single vignette – Look for clues of economic strain, low literacy, and unsafe housing together. Stress‑related coping behaviors – Emotional eating, smoking, alcohol use often accompany chronic financial or housing insecurity. Bias‑related lab/device errors – Discrepancy between clinical picture and pulse‑ox reading in darker‑skinned patients. 🗂️ Exam Traps Distractor: “Genetics explains most health differences.” – Wrong; SDH dominate over genetics for population health. Distractor: “Race‑based correction factors improve diagnostic accuracy.” – Incorrect; they perpetuate bias. Distractor: “Only low‑income groups suffer health inequities.” – Misleading; relative income position and social status matter across the spectrum. Distractor: “Providing information alone resolves health disparities.” – Incomplete; without material resources, knowledge rarely changes outcomes. --- Use this guide for rapid recall – focus on the bolded facts, the stepwise processes, and the contrasting pairs that frequently appear in exam stems.