Introduction to Social Determinants of Health Fast Facts

Social determinants of health (SDH) are the circumstances in which people are born, grow up, live, work, play and age including the economic systems and health services to address ill health (CDC).  The SDH are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries (WHO). 

Most clinicians are keenly aware of the effects of social determinants on their patients’ health but not always certain of the empiric evidence and how to apply evidence-based findings to clinical practice.  With few tools to tackle SDH, most clinicians are reluctant to screen issues that are considered outside their control.  Furthermore, medical training has traditionally been ingrained in the biomedical model and less emphasis on social and environmental factors. 

Recently, several prominent national organizations such as AMA, AAMC, ACP, AAP, AFP, and SGIM have called on physicians to adopt a population health perspective in clinical practice and to incorporate contextual factors responsible for illness. The Association of Pediatric Program Directors has promoted the assessment and management of SDH in pediatric residency as entrustable professional activities on the same level as competencies and milestones.   However, there is a dearth of educational materials applicable to trainees and practicing physicians.   Clinicians generally favor learning from clinical cases and on demand continuing medical education such as those delivered via internet and email.  We aim to meet this need by developing concise and structured review for clinicians on social determinants of health topics that may impact clinical care. 

The SDH Fast Facts series provide brief, practical, peer-reviewed and evidence-based summaries on key topics commonly encountered by clinicians and trainees caring for challenging patients.  The fast fact is structured in a quiz format starting with a patient’s clinical presentation and test results as indicated followed by multiple choice answers.  The reader is asked to pick the plausible answer based on the principle of shared decision making.  A one-liner summary of the best evidence available to date is then provided to justify the recommended course of action for each case scenario followed by literature citations. 

The series is intended to be educational and not a vehicle for presentation of case reports or for medical advice.  Trainees and health care providers should exercise their own independent clinical judgment.  The multiple choice exercise is intended to stimulate discussion rather than assess knowledge.  Most SDH topics (socioeconomic status, built environment, social networks, etc.) have not been systematically studied in clinical settings to provide best practice and guideline for clinical decision making.  Consequently, this is our best attempt to interpret and apply population health findings to “personalize” patient care.    

The SDH Fast Fact Team:

• Thuy D. Bui is a clinician-educator in the Division of General Internal Medicine at the University of Pittsburgh School of Medicine
• Joe Simonetti is an internal medicine physician and health services research fellow at the University of Washington and VA Puget Sound
• Maggie Benson is a General Internal Medicine and Women's Health Fellow at the University of Pittsburgh/ VA Pittsburgh Healthcare System
• Siamak Malek is a primary care physician, VA Pittsburgh Healthcare System
• Tim Anderson is a third-year internal medicine resident at the University of Pittsburgh Medical Center