Social Determinants of Health: The Factors Beyond You

If you've ever wondered why some individuals struggle with their health more than others—despite having access to the same medical care, you are not wrong. Unfortunately, the answer may not be found in a doctor's office or on a prescription pad. It may, however, be found in the neighborhood where you live, your current employment circumstances, or whether you can afford rent and groceries in the same month.

These factors are called social determinants of health. A better understanding and support in these areas may be the key to unlocking the optimal you.

What Are Social Determinants of Health (SDOH)?

Social determinants of health (SDOH) are the non-medical factors that significantly influence health outcomes, access to care, and quality of life.

The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, live, work and age, and the wider set of forces and systems shaping the conditions of daily life."

But let us break it down further- Social determinants include things like:

• Your neighborhood having safe sidewalks for evening strolls.
• If your job provides health insurance with good coverage and pays you enough to afford it.
• Whether the closest stores provide fresh produce versus processed items.
• Having a support system nearby, people who can help when you're sick.
• If you are having to choose between filling a prescription and paying rent this month.

These factors account for 80-90% of what determines your overall health status. Your medical care is estimated to account for only 10-20% of the modifiable contributors to your health, while the other 80-90% are due to social determinants of health.

Let that sink in- Health is beyond your genetics.

Why This Matters More Than You Might Think

Here's a statistic that should make everyone pause: Among the 500 largest U.S. cities, 56 have very large life expectancy gaps between census tracts- on average, people in one neighborhood can expect to live 20 to 30 years longer than their neighbors a few miles away. For example, in Washington, D.C., people living in the Barry Farms neighborhood face a life expectancy of 63.2 years, while less than 10 miles away, a baby born in Friendship Heights and Friendship Village can expect to live 96.1 years—a difference of almost 33 years. [7]. This represents the differing social determinants of health between the communities

The reason some communities have higher rates of diabetes, heart disease, or mental health struggles isn't coincidental—it's predictable based on the conditions of those communities, and their daily struggles.

Understanding that when the healthcare system feels impossible to navigate, when healthy choices feel out of reach, or when you can't seem to get the care you need, these are often structural reasons why. You're not failing the system. The system is failing you.

The Five Key Areas That Shape Your Health

Economic Stability:  Money Matters

Your financial situation can affect how long you'll live.

Employment and Income: When you're working multiple jobs to make ends meet, when do you have time for that routine check-up? When your job doesn't offer paid sick leave, how do you prioritize your health over your paycheck? When you're in a physically demanding job without proper safety protections, your workplace becomes a health risk.

Food Security: 47.4 million people lived in households experiencing food insecurity in 2023, including 13.8 million children — the highest rate in nearly a decade. When you're not sure where your next meal is coming from, or when fresh vegetables cost more than a fast-food meal, the "choice" to eat, or consume healthy meals for that matter, isn't really a choice at all.

Housing Stability: It is the foundation for your health and safety. If you move frequently, live in overcrowded conditions, this can impact your access to care, and susceptibility to infectious diseases. The cost of housing matters- the more that is allocated to rent/mortgage payments, the less monetary resources you have for other monthly costs.

Education: Knowledge is Power

Your education level is one of the strongest predictors of your health outcomes for the following reasons:

Health Literacy: the ability to understand medical/ insurance documents, your medical conditions, treatment plan, and prognosis

Early Childhood Development/Education: Quality and access to early education programs promote robust mental health, a lower likelihood of future substance abuse, and chronic illnesses as adults.

Educational Opportunities: Higher level education often leads to better jobs, higher income, with better benefits like health insurance. It also may translate to a better chance of navigating our complex healthcare system.

When these opportunities aren't readily available to everyone, health outcomes aren't equally attainable.

Healthcare Access: the necessities for optimal you

Having health insurance versus healthcare access differs greatly-

Provider Availability: How easily can you find a PCP? Can you see them when you need to the most? Are they located a reasonable distance from you? There are areas in this country where the nearest specialist is hours away, or not having reliable transportation may mean care isn't available to you.

Prescription Coverage: A major concern for individuals- will my insurance cover this? It also includes if your pharmacy has the medications you need available.

Navigating the System: The healthcare system is complex for most and is difficult to navigate. If you don’t know how things such as the appeal process for a denied claim or how to seek specialty care, you may be substantially disadvantaged in getting the treatment you deserve.

Your Neighborhood: Nature vs. Nurture

The built environment around you can either support or undermine your health, often in ways you might not notice.

Physical Environment: Are there sidewalks in your neighborhood? Parks? Safe places to exercise? Or are you surrounded by highways, industrial pollution? Your physical surroundings have a bearing on how much you “get out there”, exercise, and engage with your environment.

Food Environment: How many fast-food restaurants are within walking distance compared to grocery stores with fresh produce? It is often determined by policies put in place that have prioritized what is available in some communities over others.

Transportation: If you don't have a car, is public transportation available and reliable? Transportation insecurity can result in medical appointments becoming a major undertaking, potentially leading you to skip critical visits with your provider.

Safety: When your neighborhood has high crime rates, you're less likely to go for walks, let your children play outside, or feel comfortable accessing community resources. Chronic stress from safety concerns affects your physical health in measurable ways.

Social and Community Context: Your people

Social interactions are vital to humans. Our connections to others directly impact our health in multiple ways.

Social Support: When you're dealing with a health crisis, do you have people who can drive you to appointments, help with childcare, or lend a listening ear? Social isolation isn't simply loneliness—it's deadly. A comprehensive meta-analysis found that loneliness increases your risk of early death by 26%, and social isolation by 29%. About 1 in 3 adults in the U.S. report feeling lonely, and about 1 in 4 report not having social and emotional support.

Community Engagement: People who are involved in their communities—whether through religious organizations, volunteer work, or neighborhood groups—tend to have better health outcomes.

Discrimination: Experiencing discrimination based on race, gender, sexuality, or other factors creates persistent stress that can leave you susceptible to chronic illnesses.  It also affects the quality of care you receive and overall trust in healthcare providers.

Who Gets Hit Hardest?

Social determinants affect some groups disproportionately affect certain groups more than others.

Low-Income Families: When every dollar counts, healthcare often comes last. Even with insurance, co-pays and deductibles can be insurmountable. Taking time off work for appointments means lost wages.

Racial and Ethnic Minorities: Centuries of discriminatory policies have created wealth gaps, segregated communities, and unequal access to resources that persist today. This is not a thing of the past—this is our current reality, affecting our health and wellbeing in the present day.

Rural Communities: Rural Americans are at greater risk of dying from preventable causes. Specialists and hospitals are often hours away, economic opportunities are limited, and technological advancements such as high-speed internet are unavailable.

Older Adults: Fixed income, transportation challenges, and social isolation tend to compound with age. Medicare covers many services, but not all. Navigating the system also becomes challenging as cognitive abilities change.

True Stories of Real World Impact

Here's how social determinants may play out in real lives:

Maria works two part-time jobs, neither of which offers health insurance. She has diabetes but skips insulin doses to make her supply last longer because she can't afford refills. She lives in a neighborhood where the closest clinic is a two-bus transfer ride away and requires a half-day off work. When she finally gets care, it's often in the emergency room—the most expensive and least effective place to manage her chronic conditions.

James lives in a rural town where the hospital closed three years ago. His heart condition requires regular monitoring, but the nearest cardiologist is 90 miles away. At 72, he no longer feels comfortable driving long distances, and there's no public transportation. He rations his heart medication because ordering online feels risky, and the local pharmacy can't always get his specific prescription.

The Chen Family immigrated five years ago. Both parents work, but their English is limited and they don't understand how their employer's health insurance works. Their son requires follow-up care after an accident, but they received surprise bills, as they thought insurance would cover these costs. They are now afraid to seek care because of the unknown of what they may owe.

These aren't stories about individuals making bad choices. These are examples of how the system makes it impossible for people to choose what is most beneficial to them.

What's Being Done—And What Still Needs to Happen

The good news is that people are recognizing how crucial these factors are.

Healthy People 2030 is a national initiative led by the U.S. Department of Health and Human Services with specific goals for improving social determinants. This new initiative sets 10-year targets for objectives related to social determinants of health. One of its five overarching goals is to “create social, physical, and economic environments that promote attaining the full potential for health and well-being for all." The initiative sets data-driven national objectives in these areas: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment.

Healthcare Organizations are starting to screen for social needs—asking patients about food security, housing stability, and transportation challenges, and ultimately connect them with resources.

Community Programs are addressing root causes by providing opportunities through job training, access to healthy foods, and connections to affordable housing.

What has been missing?  Individual healthcare advocates to help navigate the medical system, in addition to the complex web of resources and challenges that affect health.

Where Does Solace Stand?

At Solace, we see your full picture. We understand that the right specialist isn't helpful if you can't afford to get there. We understand that your perfect treatment plan needs to fit your real life.

Solace Advocates:

Help you access resources beyond healthcare: We connect you with food assistance programs, transportation services, and financial aid for medical expenses. We know that addressing your social needs is a part of addressing your health

Make healthcare accessible: We attend appointments with you virtually, helping you ask the right questions and understand the answers. We handle the phone calls, paperwork, and follow-ups so you can focus on YOU.

Coordinate your care: We ensure all your providers understand your housing stress, your work limitations, and financial constraints. Your advocates know that your health doesn't happen in isolation.

Fight for what you need: When insurance denies coverage, when you can't get an appointment, when the system has worn you down—we step in. We know how to navigate these issues because we have a multitude of experience working in this system.

The Real Deal: It's Not Your Fault

If reading this article makes you realize that many of your health challenges stem from factors outside your control, you're not alone. The majority of what determines your health happens outside of doctors’ offices and hospitals.

This doesn't leave you powerless—it means the solutions need to be bigger than individual choices. When healthy food isn't available in your neighborhood, the answer is to make it more readily available. When people can't afford medications, the answer is to make them more affordable.

Understanding social determinants of health isn't about making excuses. It allows us to recognize what needs transformation and take action. When you understand what you are up against, you can stop blaming yourself and pursue real solutions.

Your health is affected by forces bigger than you. Solace is here to stand with you-

Whether it's connecting you with community resources, helping you navigate insurance, or simply listening, Solace advocates are here to help you work with—and around—the social factors affecting your health.

Although we cannot change your zip code overnight, we can ensure it doesn't determine your access to care. While we may not solve income inequality in your neighborhood, we can help you access every resource and service you deserve. We can help you navigate through those barriers you face.

Your health matters. Your challenges are real. The factors that make healthcare harder for you are not your fault—they're the system's failure, not yours.

Ready to have someone in your corner who understands both the healthcare system and the real world you're living in? Learn more about how Solace advocates can help you address not just your medical needs, but the full picture of what affects your health.

‍This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.