For decades, health in the U.S. has been defined primarily in terms of medical care: access to hospitals, medications, and advanced technology. But research consistently shows that these account for only a fraction of outcomes. In fact, 10–20% of modifiable health outcomes are linked to medical care, while as much as 80–90% are shaped by social determinants of health (SDOH).
SDOH, sometimes called social drivers of health, are the conditions in which people are born, live, learn, work, and age. They determine whether a treatment plan succeeds, whether a patient recovers, and whether disparities persist between communities. Recognizing and addressing these factors is essential for providers who want to improve outcomes and build equity.
Why SDOH matter now more than ever
Awareness of SDOH isn’t new. In the 1800s, German physician Rudolf Virchow proposed the concept of sociomedical causation, saying, “Medicine is a social science, and politics is nothing but medicine on a large scale.” What’s new today is the depth of data showing just how much social conditions influence health.
Consider these facts:
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Adults with a college degree live 6–11 years longer on average than those without a high school diploma.
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People experiencing housing insecurity are twice as likely to report poor physical and mental health.
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In New York City, life expectancy in East Harlem is 71 years, compared to 90 years in the Upper East Side—a difference of nearly two decades between adjoining neighborhoods.
These disparities remind us that health outcomes are not just about personal choices or medical access, but about the opportunities and environments people live in every day.
Five key areas of SDOH every provider should know
1. Think beyond medical care
Access to high-quality healthcare is vital, but it is only one piece of the puzzle. Housing, income, education, and environment can be even more influential.
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A patient with congestive heart failure may be prescribed a low-salt diet. But if they live in a food desert with only corner stores and fast-food chains, their condition may worsen despite the best clinical care.
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Someone recovering from surgery might miss follow-ups or physical therapy because they don’t have reliable transportation.
Takeaway: Asking about day-to-day realities—transportation, food, housing—can uncover obstacles that explain why a patient isn’t improving, even when care plans are followed.
2. Recognize the five domains of SDOH
Public health categorizes SDOH into five domains that providers can use as a framework:
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Economic stability: Secure employment and income make it possible to afford food, housing, and healthcare. Job loss, low wages, or medical debt all increase health risks.
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Education access and quality: Lower educational attainment is linked to lower health literacy, which can make navigating the healthcare system or understanding instructions overwhelming.
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Healthcare access and quality: Geographic location, insurance, and affordability shape whether patients can access timely, high-quality care. Rural areas are especially impacted by provider shortages.
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Neighborhood and built environment: Safe housing, clean air and water, transportation, and green space influence everything from asthma to mental health.
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Social and community context: Social support networks and community connections buffer stress, while discrimination, isolation, or lack of civic participation can undermine well-being.
Takeaway: These domains are interconnected. For example, better education often leads to higher income, which allows for safer housing, healthier food, and more consistent access to healthcare.
3. Look for health-related social needs
While SDOH describes population-level conditions, providers encounter health-related social needs (HRSNs) at the individual level.
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A teenager with asthma may live in an apartment with mold and secondhand smoke exposure, triggering frequent ER visits.
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An older adult with limited income might cut insulin doses to make their prescription last longer, putting them at risk for complications.
By screening for HRSNs, providers can identify risks that go beyond symptoms and connect patients to practical solutions. Many health systems now use short screening tools that ask about food security, housing, and transportation.
Takeaway: Even brief conversations about living conditions or resources can lead to referrals that reduce risk and improve outcomes.
4. Acknowledge barriers to equity
Health disparities don’t stem from poor decisions or lack of motivation. They stem from inequities built into social systems. Patients facing multiple disadvantages often experience compounding risks:
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Housing insecurity is linked to higher rates of chronic disease and mental illness.
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Limited education makes it harder to manage medications or navigate complex systems like insurance.
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Neighborhood disparities can shorten lives by decades, even within the same city.
Takeaway: When providers acknowledge systemic barriers, they avoid labeling patients as “noncompliant” and instead see the broader context influencing their health.
5. Reframe your role as a provider
Clinicians may feel overwhelmed by the idea of addressing social issues. But you don’t need to solve systemic problems alone. Awareness, empathy, and partnerships go a long way.
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Normalize conversations: “Many patients find transportation challenging. How do you usually get to your appointments?”
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Collaborate with care teams and community partners: Social workers, case managers, and community organizations often have resources to address housing, food, or transportation needs.
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Shift perspective: Addressing SDOH is not “extra work,” it’s a way to prevent complications, improve patient experience, and reduce avoidable costs.
Takeaway: Small steps, like asking the right questions or making a referral, can help patients overcome barriers that clinical care alone cannot fix.
Moving from awareness to action
Understanding SDOH changes the way we see health. It reminds us that medical treatment is just one piece of a much larger puzzle. Providers and organizations that integrate SDOH into practice not only improve individual outcomes, but also help close gaps that drive inequity at the community level.
To create lasting change, providers and organizations need tools, frameworks, and confidence to address SDOH consistently. Start now with our free checklist for providers, Understanding Social Determinants of Health (SDOH).
