Perspectives in primary care: a conceptual framework and path for integrating social determinants of health into primary care practice

Jennifer E. DeVoe, Andrew W. Bazemore, Erika K. Cottrell, Sonja Likumahuwa-Ackman, Jené Grandmont, Natalie Spach and Rachel Gold

Abstract

SOCIAL DETERMINANTS DRAMATICALLY INFLUENCE HEALTH

The United States falls behind other industrialized nations on most health indicators1 and remains plagued by stark health disparities. Efforts to understand the factors underlying these persistent inequalities and other shortcomings highlight the role of social determinants of health (SDH).

SDH are the nonclinical factors, such as the socioeconomic conditions and neighborhood resources, that influence patients’ health outcomes. The World Health Organization defines SDH as “the conditions in which people are born, grow, work, live and age and the wider set of forces and systems shaping the conditions of daily life.” A rich body of literature shows that SDH are associated with morbidity, mortality, and other health indicators. There is mounting evidence to suggest that SDH influence health outcomes more than medical care. Even so, attempts to address SDH in medical care settings have been limited and, for the most part, ineffective. Serious efforts to reduce health disparities and improve population health will require innovative solutions for systematically addressing SDH in all primary care settings.