Why study the social determinants of health?  Key policymakers and human service organizations have embraced the SDOH model to address and prevent adverse health and wellbeing outcomes. The Centers for Disease Control has identified the SDOH as one of three priority areas for Healthy People 2030 (CDC, 2023).  The White House has created The U.S. Playbook to Address Social Determinants of Health (2023). The U.S. Department of Health and Human Services issued a Call to Action Addressing Health-Related Social Needs in Communities Across the Nation (2023).  Finally, the World Health Organization (2010) developed the Community Social Determinants of Health model to place a global emphasis on identifying and remedying the adverse conditions that influence health outcomes.  Understanding the SDOH gives social workers a common language for community-level initiatives that target social injustices.

World Health Organization Community Social Determinants of Health

A Conceptual Framework for Action on the Social Determinants of Health

• Structural Determinants of Health (pp. 20 – 27 & 50 – 60)
• Socioeconomic Determinants of Health (pp. 27 – 35 & 50 – 60)
• Intermediary Determinants of Health (pp. 36 – 43 & 50 – 60)

Assignments

This is an overview of the interconnected, scaffolded assignments in GP III. Each assignment builds off of the previous assignment. Assignment details can be found on D2L.

Structural Determinants of Health Articles

• Kittelsen et al. – 2019 – Editorial the political determinants of health in
• Paternal Incarceration and Children’s Food Insecurity: A Consideration of Variation and Mechanisms
• Racism and Health Pathways and Scientific Evidence
• Who Cares If They Need Help Hansen, Kristina Jessen
• Food Matters
• Food Insecurity
• Prosperity Scores
• Poverty and Food Insecurity
• Racism & Food Insecurity
• Toward Critical Narrativity Inequalities in pensions and retirement from a life
• Quick to Punish An examination of the school to prison pipeline for
• Foster et al. – 2018 – Associations between proposed local government liq
• The Growth of Incarceration in the United States Exploring
• Economic adversity and crime Old Theories and new evidence
• Historical Trauma in American Indian Communities
• CRIME PREVENTION AND COMMUNITY SAFETY A CONCEPTUAL OVERVIEW
• Mwoka et al. – 2021 – Housing as a Social Determinant of Health Evidenc
• Public Education Finance Systems in the United States and U.S. Elementary and Secondary Schools
• Stoner – 2013 – Sociocultural Perspectives Applied to Transdiscipl
• Governing the Homeless in an Age of Compassion
• Understanding violence and developing resilience with African American
• Income Support Child Welfare Systems and LGBTQ Youth Homelessness
• Naik et al. – 2019 – Going upstream – an umbrella review of the macroec
• de Breij et al. – 2019 – Educational differences in macro-level determinant How colonisation determines social justice and Ind
• Naik et al. – 2017 – The macro-economic determinants of health and heal
• Rolden et al. – 2014 – Old age mortality and macroeconomic cycles Reconciliation as a Framework for Supporting Racial, Ethnic and Cultural Diversity in SOWK Education
• Benmarhnia and Zunzunegui – 2014 – On the role of social support on macroeconomic det Transdisciplinary_Public_Health_Research,_Educatio
• Burnette and Figley – 2017 – Historical Oppression, Resilience and Transcenden
• Subramanian et al. – 2002 – The macroeconomic determinants of health
• Ottova et al. – 2012 – The Role of Individual- and Macro-Level Social Det
• Ottersen et al. – 2014 – The political origins of health inequity prospect
• FEDERAL AND STATE RESPONSIfflLITIES
• Act Your (Old) Age Prescriptive,
• Talbot et al. – 2016 – Adverse Childhood Experiences in Rural and Urban C

Socioeconomic Determinants of Health Articles

• How to Write About Socioeconomic Status
• SES Fact Sheets (APA)
• Adverse Childhood Experiences, Poverty and Parenting Stress
• Adverse childhood experiences and life opportunities
• Report of the special rapporteur on extreme poverty and human rights on his mission to the United States of America
• McBride et al. – 2013 – Transdisciplinary Approaches
• Astell-Burt et al. – 2012 – Racism, ethnic density and psychological well-bein
• Danis and Pesce – 2012 – Prospects for acknowledging and addressing the soc
• Letelier et al. – 2021 – Lifetime socioeconomic determinants of health traj
• Helen Levy – 2015 – Income, Poverty and Material Hardship Among Older
• Walker et al. – 2014 – Independent effects of socioeconomic and psycholog
• Zajacova et al. – 2017 – Gender and the structure of self-rated health acro
• Phillips – 2011 – Including Gender in Public Health Research
• Davey Smith et al. – 1998 – Education and occupational social class which is
• Sabariego et al. – 2017 – Global Mental Health Costs, Poverty, Violence, an
• 2014 income and health
• Understanding Child Abuse and Neglect (Cultural and Societal Determinants)

Intermediary Determinants of Health Articles

• Safer Neighborhoods May Mitigate Risk of Child Abuse
• Adverse Childhood Experiences, Poverty and Parenting Stress
• Social Determinants of Health It’s Time to Consider the Causes of the Causes
• Subjective Poverty, Material Deprivation Indices
• Jonsson et al. – 2018 – Are neighbourhood inequalities in adult health exp
• Adverse Childhood Experiences, Poverty and Inequality
• Muskat et al. – 2017 – Complex families, the social determinants of healt
• Adverse childhood experiences and life opportunities (1)
• Fricke et al. – 2021 – Occurrence and determinants of parental psychosoci
• Tattarini et al. – 2018 – The buffering role of the family in the relationsh
• Being Well Together Individual Subjective and Com
• Harding et al. – 2015 – The Determinants of young Adult Social well-being
• Achdut et al. – 2021 – Subjective Poverty, Material Deprivation Indices a
• McCall-Hosenfeld et al. – 2014 – The Prevalence and Correlates of Lifetime Psychiat
• Mahaffey et al. – 2016 – Psychosocial Determinants of Health among Incarcer
• Brown – 2003 – Critical race theory speaks to the sociology of me

Datasets Containing Social Determinants of Health (SDoH) Measures

2019 State of Indian Education Legislative Report

• Geographic level of data: Minnesota
• Publisher: MN Department of Education
• This report provides a historical background on educational outcomes for American Indian students in the state, leading up to present day accountability factors in place under ESSA.  Includes federal vs. state definitions of American Indian students, academic achievement and environmental and biopsychosocial factors impeding educational attainment

American Community Survey (ACS)

• Geographic level of data: state, county, place, census tract, ZCTA
• Publisher: U.S. Census Bureau
• ACS data profiles include the most frequently requested demographic (DP05), social (DP02), economic (DP03) and housing data (DP04)

Area Health Resources Files (AHRF)

• Geographic level of data: county
• Publisher: Health Resources & Services Administration (HRSA)
• The AHRF data files include data on health care professions, health facilities, population characteristics, economics, health professions training, hospital use, hospital expenditures and environment

Atlas of Rural and Small-Town America

• Geographic level of data: county
• Publisher: U.S. Department of Agriculture (USDA), Economic Research Service (ERS)
• The Atlas of Rural and Small-Town America provides statistics by broad categories of socioeconomic factors: people, jobs, county classification, income and veterans

Center for Disease Control and Prevention Data and Statistics

• Geographic level of data: National, state, regional
• Publisher: Center for Disease Control
• CDC is the nation’s leading science-based, data-driven, service organization that protects the public’s health. For more than 70 years, we’ve put science into action to help children stay healthy so they can grow and learn; to help families, businesses and communities fight disease and stay strong; and to protect the public’s health

Community Resilience Estimates

• Geographic level of data: state, county, census tract
• Publisher: U.S. Census Bureau
• Community resilience is the capacity of individuals and households to absorb, endure and recover from the health, social and economic impacts of a disaster such as a hurricane or pandemic. Estimates at the tract and county level are calculated by modeling individual and household characteristics, including poverty, crowding and unemployment, from the 2019 ACS

Crime Data Explorer (CDE)

• Geographic level of data: state, county, city
• Publisher: U.S. Federal Bureau of Investigation (FBI)
• The CDE provides data on violent and property crime incidents

County Level Data Sets

• Geographic level of data: county
• Publisher: United States Department of Agriculture
• The Environmental Dataset Gateway allows access to EPA’s Open Data resources. You can find Research Laboratories linked to geospatial and non-geospatial resources (e.g., data, Web services or tools) and EPA Region and Program Office metadata

Environmental Dataset Gateway (EDG)

• Geographic level of data: county, census tract, census block group
• Publisher: U.S. Environmental Protection Agency (EPA)
• The EDG provides access to EPA’s Open Data resources, including datasets related to air, water, temperature, precipitation, flood and environmental justice

Environmental Justice Index (EJI)

• Geographic level of data: census tract
• Publisher: CDC/ATSDR
• The EJI uses data from the U.S. Census Bureau, the U.S. Environmental Protection Agency, the U.S. Mine Safety and Health Administration and the U.S. Centers for Disease Control and Prevention to rank the cumulative impacts of environmental injustice on health for every census tract. The EJI ranks each tract on 36 environmental, social and health factors and groups them into three overarching modules and ten different domains

Fatality Analysis Reporting System (FARS)

• Geographic level of data: state, county, point
• Publisher: U.S. Department of Transportation (DOT), National Highway Traffic Safety Administration (NHTSA)
• FARS is a nationwide census providing data regarding motor vehicle traffic crashes with fatal injuries

Food Environment Atlas

• Geographic level of data: state, county
• Publisher: U.S. Department of Agriculture (USDA), Economic Research Service (ERS)
• The Atlas provides estimates on three broad categories of food environment factors: food choices (e.g., access and proximity to a grocery store; number of food stores and restaurants), health and well-being (e.g., food insecurity) and community characteristics (e.g., demographic composition; recreation and fitness centers)

Health Equity Resource by Practice Area

• Geographic level of data: county, state
• Publisher: MN Department of Health
• To advance health equity, local health departments must engage in intentional practices to expand the understanding of what creates health and call attention to existing health inequities

Local Area Transportation Characteristics for Households (LATCH)

• Geographic level of data: census tract
• Publisher: U.S. Department of Transportation (DOT)
• LATCH data provides average weekday household person-miles traveled, person trips, vehicle-miles traveled and vehicle trips at census tract level

Local Area Unemployment Statistics (LAUS)

• Geographic level of data: state, county, metro area
• Publisher: U.S. Bureau of Labor Statistics (BLS)
• The LAUS portal provides data on unemployment rates by month and 12-month net changes

Location Affordability Index (LAI)

• Geographic level of data: census tract
• Publisher: U.S. Department of Housing and Urban Development (HUD)
• The LAI provides estimates of household housing and transportation costs at the neighborhood-level along with constituent data on the built environment and demographic characteristics

Mapping America’s Diversity with the 2020 Census

• Geographic level of data: census tract
• Publisher: Brookings Institute
• The 2020 census provides a once-in-a-decade picture of the U.S. population, which is used to address a variety of social, political and public policy issues. In this series, demographer William H. Frey analyzes and interprets 2020 census results based on successive Census Bureau releases of that data

Minnesota Center for Health Statistics

• Geographic level of data: Minnesota, County, Regional
• Publisher: MN Department of Health
• Information about health surveys as well as links to a wealth of statistical resources and publications. General statistics, vital statistics, surveys, publications

Minnesota Department of Aging

• Geographic level of data: Minnesota, City, County, Region
• Publisher: MN Department of Human Services
• The Aging Data Profiles include statewide, regional and county-level demographic and service data. The profiles provide information on the variation and differences about our aging society to inform those developing programs, services and supports that help older adults live, work and engage in their communities. All data is about Minnesotans age 65 and older

Minnesota Department of Education Data Center

• Geographic level of data: Minnesota, school districts
• Publisher: MN Department of Education
• Accountability and assessment, district information, early learning, food and nutrition programs, MN common course catalog, financial public reports, school finance reports, school finance spreadsheets, special education, staffing reports and student data

Minnesota Employment and Economic Development (DEED) Data Center

• Geographic level of data: Minnesota, City, State, County, Region
• Publisher: Minnesota Employment and Economic Development
• Data on employment, unemployment, wages and occupations, regional and state comparisons and more

Minnesota Department of Health

• Geographic level of data: Minnesota, City, County, Region
• Publisher: MN Department of Human Services
• Community health assessment, diseases and conditions, environmental health, health behaviors/risk factors, healthcare costs, health statistics, interactive data sources, interoperability, legislation and policy, workforce

Minnesota State Demographic Center

• Geographic level of data: Minnesota
• Publisher: MN State Demographic Center
• The SDC assists policymakers, state and local governments, businesses, nonprofits, the media and all Minnesotans locate and understand the demographic data they need to make smart decisions

Minnesota Division of Health Policy

• Geographic level of data: Minnesota, County, Regional
• Publisher: MN Department of Health
• Researches critical policy topics like health care spending and insurance coverage in Minnesota to help state policymakers and private sector leaders understand and address the unsustainable growth in health care costs

Racial Equity Data Explorer

• Geographic level of data: National, State, County
• Publisher: U.S. News & World Report
• A multifaceted digital media company dedicated to helping consumers, business leaders and policy officials make important decisions in their lives. We use world-class data and technology to publish independent reporting, rankings, journalism and advice that has earned the trust of our readers and users for nearly 90 years

Social Determinants of Health

• Geographic level of data:  all
• Publisher:  Healthy People 2030
• Safe housing, transportation and neighborhoods
• Racism, discrimination and violence; Education, job opportunities and income Access to nutritious foods and physical activity opportunities; Polluted air and water; Language and literacy skills

National Environmental Public Health Tracking Network

• Geographic level of data: county, census tract
• Publisher: CDC, National Center for Environmental Health (NCEH)
• The Tracking Network is a system of integrated health, exposure and hazard information and data from a variety of national, state and city sources

Needs Assessment: Beltrami County Community Health Needs Assessment

• Geographic level of data: Beltrami County
• Publisher: MN Department of Health
• This community health board noted the following priority health issues in 2020 and is specifically addressing the starred issues in its community health improvement plan

Social Determinants of Health Database

• Geographic level of data: county, census tract, ZCTA
• Publisher: Agency for Healthcare Research and Quality (AHRQ)
• The beta data files include data that correspond to five key SDOH domains: social context (e.g., age, race/ethnicity, veteran status), economic context (e.g., income, unemployment rate), education, physical infrastructure (e.g., housing, crime, transportation) and health care context (e.g., health insurance)

Social Determinants of Health Maps

• Geographic level of data: county, state, national, census track
• Publisher: Centers for Disease Control, the data come from multiple sources
• This interactive database provides national and state-level data about the health status and behaviors of Americans as well as environmental or policy supports. Categories include breastfeeding, fruits and vegetables, physical activity, sugar drinks, television watching and obesity/weight. Visitors can use the ‘view by’ option to examine data by demographics such as gender and race/ethnicity

Social Vulnerability Index (SVI)

• Geographic level of data: county, census tract
• Publisher: CDC/ATSDR
• The CDC/ATSDR SVI includes 15 U.S. census variables, including poverty, lack of vehicle access and crowded housing, that are grouped into four related themes, including socioeconomic status; household composition and disability; minority status and language; and housing type and transportation. Each county and census tract receives a separate ranking for each of the 15 variables, the four themes, as well as an overall SVI ranking.  Social vulnerability refers to the potential negative effects on communities caused by external stresses on human health. Such stresses include natural or human-caused disasters or disease outbreaks

Kids Count Data Book (Annie E. Casey Foundation)

• Geographic level of data: county, state, national
• Publisher: Annie E. Casey Foundation
• The KIDS COUNT Data Book provides a detailed picture of how children are faring in the United States, ranking states on overall child well-being and domains. The Data Book also contains key indicators covering economic well-being, education, health and family and community

US Census Quick Facts

• Geographic level of data: county, state, national
• Publisher: US Census Bureau
• The KIDS COUNT Data Book provides a detailed picture of how children are faring in the United States, ranking states on overall child well-being and domains. The Data Book also contains key indicators covering economic well-being, education, health and family and community

Social Determinants of Health Data: Survey Results on the Collection, Integration and Use

• Geographic level of data: all
• Publisher: NORC at the University of Chicago (NORC) and American Health Information Management Association (AHIMA)
• Better understand how SDOH is collected, coded and used; Inform the development of educational tools and resources needed by HI professionals; Inform the development of policy recommendations to further the standardization and use of SDOH data

Policy Analysis

• Addressing the Social Determinants of Health Community Health Matrix
• Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts

Supplemental Activities

For BSW students to learn about the social determinants of health:

1. AI: Have students ask ChatGPT about the social determinants of an injustice of their choosing.  Then have students map the results to the CSDH framework, selecting which determinants are structural, socioeconomic and/or intermediary and why.
2. Case Studies: Provide case studies that illustrate individuals or families facing health disparities due to social determinants. Have students analyze the cases and identify the relevant factors contributing to health disparities.
3. Community Mapping: Have students research and create a community map, identifying key social determinants of health in a specific area. This can include access to healthcare, education, employment, housing and more.
4. Guest Speakers: Invite guest speakers from local public health agencies, non-profit organizations or community health centers to share their experiences working with social determinants of health.
5. Interactive Workshops: Organize workshops on topics such as food insecurity, housing instability or access to healthcare. Engage students in activities like food bank volunteering, visiting local shelters or role-playing scenarios related to healthcare access.
6. Data Analysis: Provide students with datasets related to health disparities and social determinants. Ask them to analyze the data, identify trends and create visual representations (charts, graphs, etc.).
7. Community Needs Assessment: Have students conduct a community needs assessment. They can interview community members, observe local conditions and compile a report on the social determinants impacting health in that community.
8. Policy Analysis: Assign students to research and analyze policies at the local, state or federal levels that have implications for social determinants of health. Have them present their findings and propose policy changes or improvements.
9. Social Determinants Jeopardy: Create a game of “Social Determinants Jeopardy” where students can compete in teams to answer questions related to social determinants of health. This can be a fun and engaging way to test their knowledge.
10. Documentary Screening and Discussion: Show documentaries or films that highlight the impact of social determinants on health, such as “The Waiting Room” (about healthcare access) or “A Place at the Table” (about food insecurity), followed by group discussions.
11. Group Projects: Assign small groups of students to focus on specific social determinants of health (e.g., education, income, neighborhood safety) and have them prepare presentations or reports on how these determinants affect health outcomes.
12. Simulation Exercises: Conduct simulation exercises to give students a firsthand experience of the challenges associated with social determinants. For instance, have them role-play as low-income individuals navigating the healthcare system or seeking affordable housing.
13. Debates: Organize debates on controversial issues related to social determinants of health, such as universal healthcare, housing policies or the role of education in health outcomes. This encourages critical thinking and understanding of multiple perspectives.
14. Reflection Journals: Ask students to maintain journals throughout the course, reflecting on how their own experiences and backgrounds influence their understanding of social determinants of health.
15. Field Visits: Plan field visits to local organizations that work with populations affected by social determinants. Allow students to interact with clients and staff to gain a deeper understanding of the real-world impact.

Capstone Resources

• The Psychology of Oppression
• Social Determinants of Child Abuse and Neglect
• Center for Disease Control: The Social Determinants of Health
• Healthy People 2030
• WHO Commission on Social Determinants of Health
• Robert Wood Johnson Foundation: Commission on the SDH
• National Association of County and City Health Officials Health Equity and Social Justice
• Rural Health Information Hub: Social Determinants of Health Toolkit
• Community Toolbox: Addressing the SDH and Development
• The Best Stats You’ve Ever Seen by Hans Rosling
• The Power in Effective Data Storytelling
• Social Determinants of Health at CDC