Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into 5 domains:

Economic Stability

• Employment
• Food Insecurity
• Housing Instability
• Poverty

Education Access and Quality

• Early Childhood Development and Education
• Enrollment in Higher Education
• High School Graduation
• Language and Literacy

Health Care Access and Quality

• Access to Health Services
• Access to Primary Care
• Health Literacy

Neighborhood and Built Environment

• Access to Foods That Support Healthy Dietary Patterns
• Crime and Violence
• Environmental Conditions
• Quality of Housing

Social and Community Context

• Civic Participation
• Discrimination
• Incarceration
• Social Cohesion

Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life. Examples of SDOH include:

• Safe housing, transportation, and neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Polluted air and water
• Language and literacy skills

SDOH also contribute to wide health disparities and inequities. For example, people who don't have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.

Just promoting healthy choices won't eliminate these and other health disparities. Instead, public health organizations and their partners in sectors like education, transportation, and housing need to take action to improve the conditions in people's environments.

Goal: Help people earn steady incomes that allow them to meet their health needs.

In the United States, 1 in 10 people live in poverty, and many people can’t afford things like healthy foods, health care, and housing.

People with steady employment are less likely to live in poverty and more likely to be healthy, but many people have trouble finding and keeping a job. People with disabilities, injuries, or conditions like arthritis may be especially limited in their ability to work. In addition, many people with steady work still don’t earn enough to afford the things they need to stay healthy.

Employment programs, career counseling, and high-quality child care opportunities can help more people find and keep jobs. In addition, policies to help people pay for food, housing, health care, and education can reduce poverty and improve health and well-being.

Goal: Increase educational opportunities and help children and adolescents do well in school.

People with higher levels of education are more likely to be healthier and live longer. Healthy People 2030 focuses on providing high-quality educational opportunities for children and adolescents — and on helping them do well in school.

Children from low-income families, children with disabilities, and children who routinely experience forms of social discrimination — like bullying — are more likely to struggle with math and reading. They’re also less likely to graduate from high school or go to college. This means they’re less likely to get safe, high-paying jobs and more likely to have health problems like heart disease, diabetes, and depression.

In addition, some children live in places with poorly performing schools, and many families can’t afford to send their children to college. The stress of living in poverty can also affect children’s brain development, making it harder for them to do well in school. Interventions to help children and adolescents do well in school and help families pay for college can have long-term health benefits.

Health Care Access and Quality Overview and Objectives Evidence-Based Resources Healthy People in Action

Goal: Increase access to comprehensive, high-quality health care services.

Many people in the United States don’t get the health care services they need. Healthy People 2030 focuses on improving health by helping people get timely, high-quality health care services.

About 1 in 10 people in the United States don’t have health insurance. People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.

Sometimes people don’t get recommended health care services, like cancer screenings, because they don’t have a primary care provider. Other times, it’s because they live too far away from health care providers who offer them. Interventions to increase access to health care professionals and improve communication — in person or remotely — can help more people get the care they need.

Goal: Create neighborhoods and environments that promote health and safety.

The neighborhoods people live in have a major impact on their health and well-being.Healthy People 2030 focuses on improving health and safety in the places where people live, work, learn, and play.

Many people in the United States live in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks. In addition, some people are exposed to things at work that can harm their health, like secondhand smoke or loud noises.

Interventions and policy changes at the local, state, and federal level can help reduce these health and safety risks and promote health. For example, providing opportunities for people to walk and bike in their communities — like by adding sidewalks and bike lanes — can increase safety and help improve health and quality of life.

Goal: Increase social and community support.

People’s relationships and interactions with family, friends, co-workers, and community members can have a major impact on their health and well-being. Healthy People 2030 focuses on helping people get the social support they need in the places where they live, work, learn, and play.

Many people face challenges and dangers they can’t control — like unsafe neighborhoods, discrimination, or trouble affording the things they need. This can have a negative impact on health and safety throughout life.

Positive relationships at home, at work, and in the community can help reduce these negative impacts. But some people — like children whose parents are in jail and adolescents who are bullied — often don’t get support from loved ones or others. Interventions to help people get the social and community support they need are critical for improving health and well-being.

Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.

Health Literacy and Health Equity

Personal health literacy is associated with racial/ethnic minority status, age, poverty, health insurance coverage, educational attainment, language spoken before starting school, and self-reported health. Strategies to increase personal health literacy disproportionately benefit populations that have been marginalized and therefore have the potential to decrease health disparities.

Similarly, improving organizational health literacy may reduce disparities. For example, one aspect of being a health-literate organization is meeting the needs of populations with a range of health literacy levels. By ensuring that everyone, regardless of their abilities, can make use of health information and services, health-literate organizations advance health equity.

The National Action Plan to Improve Health Literacy called for interventions that increase both organizational and personal health literacy. On the organizational health literacy front, its goals include promoting changes in the health care system that improve communication, informed decision-making, and access to culturally and linguistically appropriate health information and services. On the personal health literacy front, it promotes accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level, as well as expanding adult education and English language instruction.

Food and nutrition insecurity are predominantly influenced by the local environment, including surrounding neighborhood infrastructure, accessibility, and affordability barriers. Access to grocery stores that carry healthy food options (such as fresh fruit, vegetables, low-fat fish and poultry) are not located equitably across residential and regional areas in the United States.

Areas that lack access to affordable, healthy foods are known as food deserts. Food deserts are:

• Found in urban or suburban neighborhoods that lack grocery stores (supermarkets or small grocery stores) that offer healthy food options.
• Found in rural areas and neighborhoods where the nearest grocery stores are too far away to be convenient or accessible.
• More prevalent in neighborhoods that are comprised of a majority of racial or ethnic minority residents or in rural AI/AN communities.
• More likely found in areas with a higher percentage of residents experiencing poverty, regardless of urban or rural designation.

Urban, suburban, and rural areas can also be overwhelmed with stores that sell unhealthy calorie-dense and inexpensive junk foods, including soda, snacks, and other high sugar foods. This is known as a food swamp. Food swamps:

• Reduce access to nutritional foods and provide easier access to unhealthy foods.
• Are a predictor of obesity, particularly in communities where residents have limited access to their own or public transportation and experience the greatest income inequality.

Reducing food and nutrition insecurity in the U.S. will require a multifaceted approach that considers, among other possibilities:

• Strategies that engage communities in local health programs; for example, recruiting community partners to assist in addressing gaps between food access and intake.
• Interventions that utilize federal food and nutritional supplemental programs, including the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC).
• Leveraging local and federal policies targeting food insecurity; for example, retail store interventions, where healthy food placement, promotion and price influence healthier choices; sweetened beverage taxes to reduce the purchase appeal to consumers; and junk food taxes balanced with removal of taxes on water and fruits and vegetables.