Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation

Abstract

A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research‐to‐practice translation gap and missed opportunity for advancing health equity. Context The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence. Methods We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms. Findings We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity. Conclusions Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer‐reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence‐based and targeted policy and programming. Such tools designed to close the research‐to‐practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.

There is no such a thing as a ‘biological’ basis for cancer disparities: A call to end misreporting of the ultimate determinants of health outcomes

“…31 While largely overlooked, SDH can account for >50% of health outcomes (Figure 2). 32 Disadvantaged populations are challenged by poor access to cancer prevention and control measures, commonly deprived of comprehensive social protection schemes for essential services, often resulting in delays in access to care, suboptimal treatments, therapeutic abandonment, discrimination and stigma. 32 The main SDH include lowincome, lower education, job and food insecurity, social discrimination, and exclusion.…”

“…32 Disadvantaged populations are challenged by poor access to cancer prevention and control measures, commonly deprived of comprehensive social protection schemes for essential services, often resulting in delays in access to care, suboptimal treatments, therapeutic abandonment, discrimination and stigma. 32 The main SDH include lowincome, lower education, job and food insecurity, social discrimination, and exclusion. Ethnical minorities in many countries are affected by an excess of adverse SDH, based on specific political will and structural discrimination.…”

Improving Hypertension Control in the Black Patient Population

“…6,7 Reasons for health inequities in the care of Black patients with uncontrolled HTN include, in part, systemic and structural barriers that prevent equitable access to education, resources, and care providers. 8 The result is persistent, uncontrolled BP (defined as an average systolic blood pressure [SBP] >140 mm Hg or an average diastolic blood pressure [DBP] >90 mm Hg among those with HTN) 9 and an associated increased risk of stroke and death. Chronic, uncontrolled BP results in a 50% increased risk of stroke and an 80% increased risk of stroke-related death among Black patients, substantially higher than that experienced by White counterparts.…”

“…1 Effective management of HTN is a primary care priority, and yet, strategies to support quality improvement (QI) efforts for BP in primary care fall short of significant, sustained improvements, particularly for patients with health-related social needs that pose challenges to resources and care access. 8 One solution increasingly used to support access to care and resources, improve communication and clinician workflow, and facilitate referrals for healthrelated social needs is the electronic health record (EHR). 13 Contemporary EHR platforms provide a digital record of care activities across settings, and can actively push electronic reminders, educational content, and support communication between patients and providers.…”

“…Evidence-based strategies include education and self-monitoring of blood pressure (SMBP),5 in conjunction with taking evidence-based medications, maintaining physical activity, and incorporating diet and lifestyle changes into everyday routines 6,7. Reasons for health inequities in the care of Black patients with uncontrolled HTN include, in part, systemic and structural barriers that prevent equitable access to education, resources, and care providers 8. The result is persistent, uncontrolled BP (defined as an average systolic blood pressure [SBP] >140 mm Hg or an average diastolic blood pressure [DBP] >90 mm Hg among those with HTN)9 and an associated increased risk of stroke and death.…”