Social Determinants of Health

What are Social Determinants of Health (SDOH)?

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.
- U.S. Department of Health and Human Services

5 SDOH Domains

• Economic Stability
• Education Access and Quality
• Healthcare Access and Quality
  • E.g. disparities in maternal mortality, discriminatory diagnostic criteria, etc.
• Neighborhood and Built Environment
  • E.g. tree equity, neighborhood amenities, environmental justice, redlining, etc. 
• Social and Community Context

Information about SDOH is available in both scholarly and grey literature. Below are a few places to search to get you started.

For help with your specific question, reach out to your subject librarian or ask your question via chat 24/7. 

Scholarly Literature Sources

Grey Literature Sources

Many current and historical methods of conducting research have created and propagated health disparities. Only by actively taking a critical look at who is being accurately represented in research and the ensuing literature can we improve our research and systems. One way to incorporate more voices into your research is to seek out these voices in grey literature, but don't forget to also seek out these perspectives in scholarly literature.

Start with a Research Question

SDOH research questions are often quite broad and must be narrowed down to effectively investigate. Learn how to develop a research question.

Keywords & Controlled Vocabulary

To find information on your topic, one of the first steps is to generate a list of related keywords. Some folks use Excel or Google Docs to organize their keywords. For a concept like economic stability, a researcher may generate an initial list of keywords that looks like this: 

• economic stability 
• economic status 
• living paycheck to paycheck 
• gig economy 

Then the researcher may take a list of terms like this to a database like PubMed, separating synonymous concepts with the Boolean Operator OR:

economic stability OR economic status OR living paycheck to paycheck OR gig economy

Based on the results of an initial search, the researcher should review the results and add or modify keywords to capture more related articles on the topic of interest. In addition to keywords, the researcher should investigate whether the database has a controlled vocabulary, i.e., a set list of terms used to describe specific concepts so the database's contents can be indexed and found by those terms.

Examples:

• MeSH in PubMed,
• Emtree in Embase,
• Subject Headings in CINAHL Complete,
• etc. (more database guides).

Thorough searching requires diligence with generating keywords.

Search Hedges

Search hedges are standardized search strategies that can be used to help retrieve relevant articles.

Hedges may be applied to improve the recall of various levels of evidence, such as randomized controlled trials, systematic reviews/meta-analyses, and to identify clinical concepts, such as diagnosis, etiology, prognosis and treatment. Hedges are also called filters, clinical queries, or optimal search strategies. They are not a guarantee of retrieving quality research; you still need to critically appraise results for quality and relevance.
- University of Alabama at Birmingham Libraries

SDOH

• "social determinants"[Title/Abstract:~2]
  (Unvalidated SDOH search by Lisa Acuff, AHIP (Feb. 2023)

This search using a proximity operator in PubMed that retrieves 'social and structural determinants of health' and 'social and psychological determinants'; where 'social determinants' does not appear next to 'of health'; where 'health' is modified like 'social determinants of oral health' or 'social determinants of mental health'; and other variations like 'social determinants of vulnerability' or 'social determinants of racial disparities'.

Healthcare Disparities

Challenges of Researching SDOH

Social Determinants of Health evolve continuously based on current research, knowledge, and understanding. The more researchers become aware of inequitable systems that determine a portion of the population's health, the more the list of SDOH will adapt and grow.

"There are a variety of cover terms to understand the determinants of health. These include fundamental cause, economic inequality and power relationships. A group in Canada, National Collaborating Centre for Determinants of Health, has produced some material that may be of value in discussing power's effect on health." - Stephen Bezruchka, MD, MPH, Departments of Health Systems and Population Health & of Global Health, School of Public Health, University of Washington shared via the American Public Health Association (APHA) Spirit of 1848 listserv.

Social justice includes research through an inclusive lens that centers communities. 

As you are conducting your research, keep these questions in mind - 

• Have you spoken over or for historically excluded communities rather than listening to the issues the community wants to address?
• Have you sought out research from diverse perspectives? Think about race, ability, gender identity, etc.
• Have you accounted for the impacts of racism over time? E.g., structural racism and economic/social injustice methods, such as redlining and creating unequal access to resources like education, food & healthcare.

Learn more from 

Venkateswaran N, Feldman J, Hawkins S, et al. Bringing an Equity-Centered Framework to Research: Transforming the Researcher, Research Content, and Practice of Research Research Triangle Park (NC): RTI Press; 2023 Jan. 

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