Social Determinants of Health Resources

This page contains resources to help staff at Community Health Centers and Primary Care Associations learn more about the social determinants of health.

For a basic introduction to health equity and health disparities and to access tools, articles, and guides on implementing health equity initiatives, please visit the CHAMPS Health Equity Resources webpage.

To access the Rural Social Determinants of Health Game Toolkit, a resource designed to introduce health center and PCA staff to the social, cultural, economic, environmental, and other factors that impact the health of rural patients, please scroll down to the bottom of this page or click here.

Please scroll down or use the links below to explore the following topics:

Access to Healthcare Services
Culture, Literacy, and Language
Education and Employment
Environment
Food and Nutrition
Housing and Homelessness
Legal Services and Public Policy
Poverty and Income
Race and Ethnicity
Sex, Gender, and Sexual Orientation
Technology and Transportation

 

ACCESS TO HEALTHCARE SERVICES

Health-Care Access as a Social Determinant of Health
McGibbon E., Etowa J., and McPherson C.
Can Nurse (2008)

www.ncbi.nlm.nih.gov/pubmed/18856224
Explains how inequities in access to healthcare services impact health outcomes, and offers suggestions for using a social justice perspective to break the cycle of inequity.

Healthcare Access in Rural Communities
Rural Health Information Hub
www.ruralhealthinfo.org/topics/healthcare-access
Outlines the impact that lack of access to healthcare services has on residents of rural communities, and provides resources for addressing this lack of access.

Visit the CHAMPS Community, Migrant, Homeless, and Public Housing Health Centers webpage to learn more about how health centers expand patient access to care, and to locate a health center near you in Region VIII (CO, MT, ND, SD, UT, WY).

Visit the CHAMPS Outreach & Enrollment Resources webpage to explore resources designed for health center staff that help expand patient access to healthcare services.

Technology and transportation are closely connected to a patients’ access to health care services. Click here or scroll down on this page to view information and resources related to technology and transportation.

 

CULTURE, LANGUAGE, AND LITERACY

Reach Out and Read
www.reachoutandread.org
Nonprofit organization that gives young children a foundation for success by incorporating books into pediatric care and encouraging families to read aloud together.

Think Cultural Health
US Department of Health and Human Services
www.thinkculturalhealth.hhs.gov/clas
Provides information about the National Culturally and Linguistically Appropriate Services (CLAS) Standards.

What is Cultural Competency?
Office of Minority Health
www.cdc.gov/nchhstp/socialdeterminants/docs/what_is_cultural_competency.pdf
Defines cultural and linguistic competence and several related terms, and explains the influence of culture and language on health.

Visit the CHAMPS Cultural Competency Resources webpage to learn more about how culture and language impact health.

Visit the CHAMPS Health Literacy Resources webpage to access information on patient literacy and plain language, training materials for health center staff, and tools for implementing health literacy policies at your health center.

 

EDUCATION AND EMPLOYMENT

Education: A Lifelong Social Determinant of Health
American Public Health Association
https://storify.com/APHA/sdoh-education
Article summarizing the effects of education on health across the lifespan.

Education and Education Policy as Social Determinants of Health
American Medical Association Journal of Ethics
http://journalofethics.ama-assn.org/2006/11/pfor1-0611.html
Journal article describing how education functions as a predictor of long-term health and quality of life.

Education and Health
Robert Wood Johnson Foundation
www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70447
Issue brief summarizing the evidence linking education with health.

Education and Health Fact Sheet
Mountain States Regional Health Equity Council
https://docs.google.com/viewer?a=v&pid=sites&srcid=bnBhLXJoZWMub3JnfHJlZ2lvbjh8Z3g6M2U0MGRlZjJlMDFlYzE4Mg
One-page flyer that discusses education as a social determinant of health and its impact on African American/black and Hispanic/Latino communities in Region VIII.

Employment Conditions as Social Determinants of Health
Lahiri S., Moure-Eraso R., Flum M., Tilly C., Karasek R., Massawe E. (2006)
Part 1: www.ncbi.nlm.nih.gov/pubmed/17145642
Part 2: www.ncbi.nlm.nih.gov/pubmed/17317640
Journal articles examining both the external (Part 1) and internal (Part 2) employment conditions that effect health.

How Does Employment, or Unemployment, Affect Health?
Robert Wood Johnson Foundation
www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf403360
Issue brief examining the health effects of employment and unemployment on health.

 

ENVIRONMENT

Environmental Determinants of Disease
HealthKnowledge.org
www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2f-environment/environmental-determinants-disease
Summarizes the ways that natural and built environments and the policies that impact these environments affect population health on both a local and global scale.

Preventing Disease Through Healthy Environments
World Health Organization
http://apps.who.int/iris/bitstream/10665/204585/1/9789241565196_eng.pdf?ua=1
A global assessment report of the disease burden caused by environmental risks.

Saving Energy, Saving Lives: The Health Impacts of Avoiding Power Plant Pollution with Energy Efficiency
Physicians for Social Responsibility
http://efficiencyforall.org/wordpress/wp-content/uploads/2017/04/h1801.pdf
Describes the public health effects of power plant pollution and outlines strategies to address these negative health outcomes through increased energy efficiency.

United States Environmental Protection Agency
Webpages providing information on the health impacts of several environmental factors:
Research on Health and Environmental Effects of Air Quality
www.epa.gov/air-research/research-health-and-environmental-effects-air-quality
Human Health and Climate Change Research
www.epa.gov/climate-research/human-health-and-climate-change-research
Health and Water Research
www.epa.gov/water-research/health-and-water-research

 

FOOD AND NUTRITION

Addressing Access to Affordable and Nutritious Food for Underserved Populations
Health Outreach Partners
https://outreach-partners.org/2014/05/13/social-determinants-of-health-addressing-access-to-affordable-and-nutritious-food-for-underserved-populations/
Describes how lack of access to affordable, nutritious food influences health and quality of life.

Food Security in the U.S.
United States Department of Agriculture
www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/
Defines food security and provides links to information on nutrition assistance, food choices and health, data resources, and more.

Hunger and Obesity: Understanding a Food Insecurity Paradigm
Institute of Medicine (2011)
https://fns-prod.azureedge.net/sites/default/files/IOMHungerObesity.pdf
Explores the relationship between food insecurity and obesity.

Nutrition as a Social Determinant of Health: Addressing Malnutrition and Food Insecurity through Screening, Policy, and Partnerships
National Summit on Social Determinants of Health
www.rootcausecoalition.org/wp-content/uploads/2016/12/Nutrition-as-a-SDoH-Addressing-Malnutrition-and-Food-Insecurity-through-Screening-Policy-and-Partnerships-Raimondi-BlankenshipBlancato-Zwerdling.pdf
Slides from the 2016 National Summit presentation on best practices for addressing nutrition inequities.

 

HOUSING AND HOMELESSNESS

CMS Informational Bulletin: Coverage of Housing-Related Activities and Services for Individuals with Disabilities
Centers for Medicare and Medicaid Services (2015)
www.medicaid.gov/federal-policy-guidance/downloads/CIB-06-26-2015.pdf
Clarifies the circumstances under which Medicaid reimburses for certain housing-related activities that aim to promote community integration of individuals with disabilities, older adults, and adults experiencing homelessness.

Housing and Health Fact Sheet
Mountain States Regional Health Equity Council
https://docs.google.com/viewer?a=v&pid=sites&srcid=bnBhLXJoZWMub3JnfHJlZ2lvbjh8Z3g6NTcwYjQ5NDIxOGFkMDgwNg
One-page flyer that discusses housing as a social determinant of health and its impact on African American/black and Hispanic/Latino communities in Region VIII.

Mapping Inequality: Redlining in New Deal America
University of Richmond
https://dsl.richmond.edu/panorama/redlining
Introduction to the history of redlining and its impact on contemporary housing inequality.

Visit the CHAMPS Homeless and Public Housing Resources webpage to access additional information and resources on this topic.

 

LEGAL SERVICES AND PUBLIC POLICY

The Case for More Active Policy Attention to Health Promotion
Health Affairs
J. Michael McGinnis, Pamela Williams-Russo, and James R. Knickman (2002)
https://doi.org/10.1377/hlthaff.21.2.78
Explores the factors inhibiting policy attention and resource commitment to the non-medical determinants of population health and suggests approaches for sharpening the public policy focus to encourage disease prevention and health promotion.

Law in a Social Determinants Strategy: A Public Health Law Research Perspective
Robert Wood Johnson Foundation
www.cdc.gov/socialdeterminants/docs/burris-sdoh-symposium-101910-508.pdf
Presentation slides outlining the crucial connection between health law and efforts to address social determinants of health.

National Center for Medical-Legal Partnership
Department of Health Policy and Management, Milkin Institute School of Public Health, George Washington University
http://medical-legalpartnership.org
Works to improve the health and wellbeing of individuals and communities by leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions.

 

POVERTY AND INCOME

Key Facts: Poverty and Poor Health
Health Poverty Action
www.healthpovertyaction.org/info-and-resources/the-cycle-of-poverty-and-poor-health/key-facts/
Describes the ways that poverty functions as both a cause and a consequence of poor health.

Income: Lower Wages Come at a Cost to Public Health
American Public Health Association
https://storify.com/APHA/sdoh-income
Explains the connection between rising health care costs, reduced income, and poor health.

Income, Wealth, and Health
Robert Wood Johnson Foundation
www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70448
Issue brief summarizing the evidence tying income and wealth to health outcomes.

Visit the CHAMPS Offsetting Patient Costs webpage to access resources on making healthcare costs more affordable for low-income patients.

 

RACE AND ETHNICITY

Explore Health Equity By Topic: Race/Racism
National Association of County and City Health Officials
www.unnaturalcauses.org/resources.php?topic_id=8
Provides background information and educational resources on how racism leads to poorer health.

HHS Action Plan to Reduce Racial and Ethnic Health Disparities
Office of Minority Health
https://minorityhealth.hhs.gov/assets/pdf/hhs/HHS_Plan_complete.pdf
Outlines goals and actions the Department of Health and Human Services (HHS) will take to reduce health disparities among racial and ethnic minorities.

Racial and Ethnic Approaches to Community Health (REACH)
Centers for Disease Control and Prevention
www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/
National program to reduce racial and ethnic health disparities. Awards funding to programs that carry out local, culturally appropriate programs that address a wide range of health issues among African Americans, American Indians, Hispanics/Latinos, Asian Americans, Alaska Natives, and Pacific Islanders.

Structural Racism and Health Inequities
Cambridge University Press
Gilbert C. Lee and Chandra L. Ford (2011)
www.ncbi.nlm.nih.gov/pmc/articles/PMC4306458/
Details the links between both individual and structural racism and health outcomes.

 

SEX, GENDER, AND SEXUAL ORIENTATION

Gender Differences in Determinants and Consequences of Health and Illness
Journal of Health, Population, and Nutrition
Carol Vlassoff (2007)
www.ncbi.nlm.nih.gov/pmc/articles/PMC3013263/
Reviews studies on the interaction between gender and the determinants and consequences of chronic diseases to illustrate how these interactions can lead to different approaches to prevention, treatment, and disease management.

Gender Inequity in Health: Why It Exists and How We Can Change It
World Health Organization
www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf?ua=1
Report by the Women and Gender Equity Knowledge Network on global gender inequities, their impact on health, and promising practices for addressing this challenge.

Social Determinants of Sexual and Reproductive Health
World Health Organization
http://apps.who.int/iris/bitstream/10665/44344/1/9789241599528_eng.pdf
Report describing the relationship between the social determinants of health and sexual and reproductive health, as well as promising programs for reducing inequities in access to sexual and reproductive health services.

Tackling Health-Care Disparities Among Sexual Minorities
Women’s Health Matters
www.womenshealthmatters.ca/feature-articles/feature-articles/health-sexual-minorities/
Article explaining the link between sexual orientation and poorer health.

Visit the CHAMPS LGBT Resources webpage for additional information and resources on improving access to quality healthcare for LGBT patients.

 

TECHNOLOGY AND TRANSPORTATION

Actions to Accelerate Adoption and Accessibility of Broadband-Enabled Health Care Solutions and Advanced Technologies
American Medical Informatics Association
www.amia.org/sites/default/files/AMIA-Response-to-FCC-Notice-on-Accelerating-Broadband-Health-Tech-Availability.pdf
Letter from the AMIA to the Federal Communication Commission urging this agency to improve internet access for specific populations to allow for the more widespread use of health technology.

Broadband Connectivity is a Social Determinant of Health
Huffington Post
www.huffingtonpost.com/jane-sarasohnkahn/broadband-connectivity-is_b_11059720.html
Article examining the growing need for telehealth and broadband internet in nonurban communities.

How Does Transportation Impact Health?
Robert Wood Johnson Foundation
www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf402311
Issue brief examining the ways in which the U.S. transportation system impacts population health, from pollution and automobile accidents to decreased physical activity.

Social Media, Knowledge Translation, and Action on the Social Determinants of Health and Health Equity: A Survey of Public Health Practices
SpringerLink
Sume Ndumbe-Eyoh, Agnes Mazzucco (2016)

https://link.springer.com/article/10.1057%2Fs41271-016-0042-z
Outlines the role of social media in impacting the social determinants of health, including opportunities to enhance the use of social media to improve public health.

Transportation and Health
American Public Health Association
www.apha.org/topics-and-issues/transportation
Discusses how transportation options and decisions impact health, as well as suggestions for developing healthy communities through transportation policy and infrastructure planning.

Visit the CHAMPS Health Information Technology webpage for resources on new health center technology and ways to improve healthcare access and quality through technological advancement.

 

RURAL SOCIAL DETERMINANTS OF HEALTH GAME TOOLKIT

Purpose: The Rural Social Determinants of Health Game Toolkit was developed in 2017-2018 by the Cultural Competency Team, an inter-office collaboration between Colorado Community Health Network (CCHN) and Community Health Association of Mountain/Plains States (CHAMPS). The purpose of the Toolkit is to educate healthcare professionals about the ways that social, cultural, economic, environmental, and other factors impact the health and wellbeing of rural patients. The game is appropriate both for staff who are already familiar with the social determinants of health, health disparities, and other related concepts, and for staff who are new to these terms and ideas. Ultimately, the goal of this game is to broaden players’ understanding of rural patient experiences and the many factors inside and outside of the clinic that can lead to better or worse health, as well as to foster productive discussions about these effects.

How to Play: This game is designed to represent one year in the life – and health – of fictional patients living in a rural western community. At the start of the game, each player chooses a profile card that provides information about who they are. Players move across the game board by rolling two dice, stopping on orange squares (risk factors) and blue squares (protective factors) that either harm or improve their health and wellbeing. Players also make four “clinic stops” at their local CHC, and roll one die each time to determine the quality of their experience there. At the end of the game, players calculate their overall health status at the year’s end. After the game is over, the facilitator leads players through a discussion of the game so that they can process their experiences together and consider the connections between the game and the lives of the patients they serve.

Access: All the resources needed to play this game are available for free download via the links below. CHCs and other safety-net health facilities that operate in rural areas may use this game as a fun, simple introduction to the social determinants of health for staff, students, and/or board members. Others may use this game to begin conversations about how to integrate the pursuit of health equity into clinical practice. This game is also appropriate for partner organizations such as schools, religious organizations, or community groups that wish to better understand how the social determinants of health affect rural communities.

Acknowledgements: The Cultural Competency Team wishes to acknowledge that the original concept for this game is derived from the CityMatCH Life Course Game. This game was developed by CityMatCH and its partners, Contra Costa Health Services and the California Endowment. The CCHN/CHAMPS Cultural Competency Team has adapted all game materials with the express written permission of CityMatCH, and sincerely thanks CityMatCH and their partners for allowing us to build upon their amazing work. The Cultural Competency Team also wishes to thank William Chamu for designing the game board for this toolkit.

To play this game at your organization, you will need to download and print the following free resources. Please refer to the Facilitators Guide for specific set-up instructions.

Facilitators Guide
Game Board
Instructions
Player Profiles
Protective Factor Cards
Risk Factor Cards

Click here to complete a brief evaluation survey about the Rural Social Determinants of Health Game Toolkit.