A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming.
We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH.
In light of scarce existing SDOH mitigation strategies, the framework addresses an important research-to-practice translation gap and missed opportunity for advancing health equity.
Conceptualizing the Mechanisms of Social Determinants of Health!
I. SDOH
Health inequities are most often understood as associated with the social determinants of health (SDOH)
II. Opportunity
A practical, heuristic framework for policymakers, practitioners, and researchers is needed to serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence
- Unifying principles
1. SDOH are underlying causes of health inequities
-> Meaningful community engagement in data generation and interpretation for understanding and mitigating underlying health inequity drivers and multilevel resilience factors
2. SDOH shape health inequities through contextual influences
-> Development, evaluation, and scale up of multilevel interventions that address the mechanisms of SDOH at the structural, psychosocial, and clinical/biomedical levels
3. SDOH contextual disadvantage is not deterministic
-> Adoption of individualized/differentiated, decentralized, and community-based service delivery models
4. SDOH shape health over the life course
-> Proactive intervention focused on prevention and health promotion as well as restorative care to maintain and improve physical, mental, and psychosocial functioning and quality of life
5. SDOH operate through biological embedding
-> Greater prioritization of harmful SDOH mechanisms and mitigation of their biological impact in clinical education and practice, including investment in biomarkers for early detection of and intervention on emerging disease trajectories
6.SDOH operate intergenerationally
-> Prioritization of family-based approaches to restorative health care, prevention, and health promotion
7. SDOH shape clustering and synergies of health inequities
-> Greater integration of comprehensive, interdisciplinary, team-based health services delivered within a value-based framework and at the top of providers’ licenses
8. SDOH mechanisms to produce health inequities
-> Departure from vulnerability- and deficiency-focused paradigms for understanding health inequities toward multilevel resilience-focused paradigms for reducing health inequitiess
An Organizing Framework of SDOH Mechanisms
1. Underlying causal factors
-> Two distinct classes of social influence: SDOH capital and SDOH processes
2. Mediating factors
-> Two mechanisms: environmental and behavioral exposure and biological susceptibility
3. Moderating factors
-> Resilience – as collective action that supports the ability of communities to thrive when confronted with structural challenge
4. Health inequity outcomes
-> The impact of SDOH mechanisms on health inequities is dependent on the broader patterns of morbidity within the community of interest
Check out the article by Marco Thimm-Kaiser, Adam Benzekri and Vincent Guilamo-Ramos here:
