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. Please contact the CHAMPS Programs Coordinator, Population Health if you have any questions about these materials or would like to share any other useful resources.

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 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
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
SDOH and Life Course Games
Other Online SDOH Resources


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

Social Determinants of Health and Medicaid: Policy Recommendations to Achieve Greater Impact on Reducing Disparities & Advancing Health Equity
America’s Health Insurance Plans (AHIP)
Issue brief on Medicaid’s unique opportunity to address the social risk factors that disproportionately impact vulnerable populations.

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 patient’s access to healthcare services. Click here or scroll down on this page to view information and resources related to technology and transportation.


Address Language Differences Tool
Agency for Healthcare Research and Quality (AHRQ)
Excerpt from the full AHRQ Health Literacy Universal Precautions Toolkit that offers resources to address language and sensory differences as part of addressing health literacy and disparities.

Reach Out and Read
A 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
Provides information about the National Culturally and Linguistically Appropriate Services (CLAS) Standards.

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 Attainment Linked to Health Throughout Lifespan: Exploring Social Determinants of Health
American Public Health Association
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
Journal article describing how education functions as a predictor of long-term health and quality of life.

Education and Health
Robert Wood Johnson Foundation
Issue brief summarizing the evidence linking education with health.

Employment Conditions as Social Determinants of Health
Lahiri S., Moure-Eraso R., Flum M., Tilly C., Karasek R., Massawe E. (2006)
Part 1:
Part 2:
Journal articles examine both the external (Part 1) and internal (Part 2) employment conditions that affect health.

How Does Employment, or Unemployment, Affect Health?
Robert Wood Johnson Foundation
Issue brief examining the health effects of employment and unemployment on health.

Poor Education Predicts Poor Health – A Challenge Unmet by American Medicine
National Academy of Medicine
Commentary on the nexus of poor education and poor health.


Environmental Determinants of 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
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
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
Human Health and Climate Change Research
Health and Water Research


Addressing Access to Affordable and Nutritious Food for Underserved Populations
Health Outreach Partners
Describes how lack of access to affordable, nutritious food influences health and quality of life.

Disrupting Food Insecurity: Tapping Data for Strategies That Tackle the Root Causes
Urban Institute
Report on several factors that contribute to a higher rate of food insecurity in rural areas. The report features an interactive map with county-level data on these risk factors and a rural-specific list of facts and resources to disrupt food insecurity.

Food Security in the U.S.
United States Department of Agriculture
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)
Explores the relationship between food insecurity and obesity.


Addressing Health Equity through Health and Housing Partnerships
Corporation for Supportive Housing and National Health Care for the Homeless Council (May 2019)
Provides background information on health disparities, and the goal of health equity, with a focus on people who are experiencing or have experienced homelessness; explores how health centers and supportive housing providers are uniquely positioned to advance health equity; offers suggestions for how health centers and supportive housing providers can work together and on their own to identify and address disparities and advance health equity.

CMS Informational Bulletin: Coverage of Housing-Related Activities and Services for Individuals with Disabilities
Centers for Medicare and Medicaid Services (2015)
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.

Homelessness & Health: What’s the Connection?
National Health Care for the Homeless Council (NHCHC) (2019)
Outlines how health and homelessness are intertwined and why housing is health care.

Key Informant Perspectives on Rural Housing and Health
University of Minnesota Rural Health Research Center
A policy brief presents findings from key informant interviews with representatives of national organizations working in the housing sector. Researchers share rural-specific housing barriers, including those that are related to health, and policy recommendations for addressing housing challenges to improve rural health.

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

Social Determinants of Health Housing Fact Sheet
Southern Public Health Unit Network
Two-page flyer discussing housing as a social determinant of health and its impact on communities and individuals.

Social Determinants of Health: Predictors of Health among People without Homes
NHCHC (2016)
Reviews the SDOH most commonly associated with homelessness and provides resources to address these issues within the health care setting.

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


The Case for More Active Policy Attention to Health Promotion
Health Affairs
J. Michael McGinnis, Pamela Williams-Russo, and James R. Knickman (2002)
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
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
Works to improve the health and well-being of individuals and communities by leading health, public health, and legal sectors in an integrated, upstream approach to combating health-harming social conditions.

Understanding and Addressing Health Disparities and Health Needs of Justice-Involved Populations
Public Health Reports
Juliet Bui, Minh Wendt, and Alexis Bakos (2019)
Examines the health of the justice-involved population and their families, proposes policies and interventions to address their health needs, assesses how population health surveys can provide better information about the justice-involved population, and identifies opportunities for bridging knowledge gaps on health disparities and health needs.


Improving Health by Increasing the Minimum Wage
American Public Health Association
Policy Statement that explains the connection between rising health care costs, reduced income, and poor health.

Income, Wealth, and Health
Robert Wood Johnson Foundation
Issue brief summarizing the evidence tying income and wealth to health outcomes.

Key Facts: Poverty and Poor Health
Health Poverty Action
Describes the ways that poverty functions as both a cause and a consequence of poor health.

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


Children of Color’s Health Can Be Affected By Racism. Here’s What Doctor’s Can Do To Help
American University Radio
Information on the impact of racism on children of color’s health along with recommendations for health care providers.

Education and Health: Long-Term Trends by Race, Ethnicity, and Geography, 1997-2017
The Urban Institute
Stacey McMorrow, Laura Skopec, Tyler Thomas (2019)
Assesses trends in self-reported measures of general health, mental health, activity limitations, and obesity by educational attainment from 1997-2017, using data from the National Health Interview Survey.

Explore Health Equity By Topic: Race/Racism
National Association of County and City Health Officials
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
Outlines goals and actions the Department of Health and Human Services (HHS) will take to reduce health disparities among racial and ethnic minorities.

How Does Race Impact Childbirth Outcomes?
Georgetown University School of Nursing & Health Studies
Explores childbirth outcome disparities based on race and other social determinants of health.

How History Has Shaped Racial and Ethnic Health Disparities
A timeline of historically significant U.S. federal policies and events spanning the early 1800s to today that have influenced present-day health disparities.

Racial and Ethnic Approaches to Community Health (REACH)
Centers for Disease Control and Prevention
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.

Rural, Minority Social Determinants of Health Research Alert
Rural Health Research Gateway
Contains four policy briefs which examine the social determinants of health among specific minority populations.

Structural Racism and Health Inequities
Cambridge University Press
Gilbert C. Lee and Chandra L. Ford (2011)
Details the links between both individual and structural racism and health outcomes.


Gender Differences in Determinants and Consequences of Health and Illness
Journal of Health, Population, and Nutrition
Carol Vlassoff (2007)
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
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
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.

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


Broadband Connectivity is a Social Determinant of Health
Huffington Post
An article examining the growing need for telehealth and broadband internet in non-urban communities.

How Does Transportation Impact Health?
Robert Wood Johnson Foundation
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
Sume Ndumbe-Eyoh, Agnes Mazzucco (2016)
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 Equity, Health, and Aging: A Novel Approach to Health Longevity with Benefits Across the Lifespan
National Academy of Medicine (NAM)
Explores the potential partnership between the health care and transportation fields that could facilitate a balanced perspective that can appropriately weigh safety risks against the consequences of restricting mobility.

Transportation and Health
American Public Health Association
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.


Australian Rural Health Game Toolkit
The University of Sydney School of Rural Health
Based on the CHAMPS/CCHN Rural Social Determinants of Health Game found below, this Australian adaptation is designed to support learners’ understanding of the social, cultural, historical, economic, and environmental factors contributing to health disparities and inequity experienced by people living in rural Australia, as well as foster discussion about these effects at the individual, community, and population level.

CityMatCH Life Course Game 
CityMatCH, Contra Costa Health Services, and California Endowment
This Life Course Toolbox is an online resource for Maternal Child Health (MCH) researchers, academics, practitioners, policy advocates, and others in the field to share information, innovative strategies, and tools to integrate the Life Course Perspective into MCH work at the local, state, and national levels.

Rural Social Determinants of Health Game Toolkit
Community Health Association of Mountain/Plains States (CHAMPS) and Colorado Community Health Network (CCHN) 
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.

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 well-being 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 well-being. 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.

Acknowledgments: 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 thank 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 Facilitator Guide for specific set-up instructions.

Facilitator Guide
Game Board
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.


Conversations on Health Care Podcast
Hosts Mark Masselli and Margaret Flinter speak with Dr. Kirsten Bibbins-Domingo, Chair of the Department of Epidemiology and Biostatistics at the University of California at San Francisco. She discusses a recent National Academy of Medicines, Engineering, and Medicine report on ways to incorporate social care into health care, shifting the American health system towards better management of upstream causes of poor health.

An organization that helps healthcare systems and community partners improve outcomes, control costs, and advance equity by addressing social determinants of health.

Health Center Resource Clearinghouse
A clearinghouse of health center resources. Click the ‘Social Determinants of Health’ option to learn more on this topic. Social Determinants of Health
Overview of social determinants of health (SDOH) and how Healthy People 2030 addresses SDOH.

Innovative Collaboration to Improve Social Determinants of Health in Philadelphia: Webinar Archive
National Nurse-Led Care Consortium
An archived webinar on innovative programming to address the social determinants of health.

Oregon Primary Care Association: Social Determinants of Health
An overview of frequently asked questions about SDOH from the Oregon Primary Care Association (OPCA).

Purpose in Practice Podcast
Association of Clinicians for the Underserved (ACU)
A podcast that features interviews with healthcare providers and experts to discuss ways to advance health equity and improve the quality of healthcare for underserved communities.

The Public Health Foundation: TRAIN Learning Network SDOH Training Plan
A training plan through which participants can learn to describe the fundamental aspects of SDOH, explain social contexts and effects of SDOH on specific populations, and apply SDOH knowledge to design targeted interventions for improving public health.

The Role of Social Determinants of Health in Promoting Health Equity: Webinar Archive
An archived webinar that provides an overview of the Social Determinants of Health and describes how these determinants promote health equity. It also explores the relationship between SDOH and implicit bias. Participants also learn how cultural humility may be used to address unconscious biases.

Social Determinants of Health 101 for Health Care: Five Plus Five
National Academy of Medicine (NAM)
Background on SDOH and health care’s role. (2017)

Social Determinants of Health in Rural Communities Toolkit
Rural Health Information Hub
Toolkit that compiles evidence-based and promising models and resources to support organizations implementing programs to address social determinants of health in rural communities across the United States.

Social Determinants of Health Vendor Guide
Community Health Care Association of New York State (CHCANYS)
Resource for health centers on vendors related to Social Determinants of Health. The resource includes information on 11 vendors across the market.

Understanding and Addressing Social Determinants of Health: Opportunities to Improve Health Outcomes
A Guide for Rural Health Care Leaders
An 11-page guide to help rural leaders/care teams learn and address issues to improve their community’s health.

Understanding the Social Determinants of Health: A Self-Guided Learning Module for Rural Health Care Teams
An interactive self-guided resource to assist users in researching health information about rural America and specific local counties. Users can then compare this information to other U.S. counties or regions.

Visit the CHAMPS Victims and Survivors of Human Trafficking Resources webpage to access tools, articles, and guides on serving victims and survivors of human trafficking.

Visit the CHAMPS Victims and Survivors of Intimate Partner Violence Resources webpage to access tools, articles, and guides on serving victims and survivors of intimate partner violence (IPV).