Social determinants of health (SDOH) are economic, social, and physical environment factors and conditions that shape a person’s daily life,1 impact access to health care, and influence the risk of developing chronic diseases. In the free-access lecture Social Determinants of Health: COVID-19 Vulnerability and the Functional Medicine Model, subject matter and functional medicine experts explain how SDOH and social needs of health are associated with SARS-CoV-2 exposure and with vulnerability to severe COVID-19 infection. The panel of physicians, educators, and researchers affiliated with the Veterans Administration also discuss the application of SDOH in clinical practice by mapping SDOH onto the functional medicine matrix as antecedents, triggers, and mediators of physiological dysfunction.
Socioeconomic status, including education, income and occupation measures, food insecurity and healthy food access, social relationships and support, environmental factors such as air pollution, and social conditions such as chronic stress, racism, and discrimination are examples of SDOH that impact the development of chronic conditions such as obesity, cardiometabolic and cardiovascular diseases, and chronic kidney disease.2-10 In this lecture, panelists dive into the relationship between SDOH, chronic disease, and risk factors for serious COVID-19 outcomes and present an awareness of how SDOH inequities, such as disparities in exposures and quality healthcare access, intersect and impact root causes of disease.
Awareness of health disparities and social factors that may be underlying chronic conditions is essential when providing personalized care and developing the most effective and sustainable health plans. Nutrition interventions, for example, are essential therapeutic strategies for combatting many chronic diseases, yet food insecurity and limited access to affordable, varied, and nutritious foods, as seen in food deserts, may impede healthcare efforts. As noted in the lecture, the COVID-19 pandemic has highlighted limitations of the conventional medical system model, with complex factors such as SDOH not readily considered, but still influencing patient outcomes. The panelists discuss recognizing the social determinants and social needs of health for individual patients and incorporating those factors into clinical evaluations through the functional medicine matrix and timeline tools for optimal patient-centered care.
- Office of Disease Prevention and Health Promotion. Social determinants of health. Published 2020. Accessed November 25, 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
- Office of Disease Prevention and Health Promotion. Food insecurity. Published 2020. Accessed November 25, 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/food-insecurity
- Wang A, Kho AN, French DD. Association of the Robert Wood Johnson Foundations’ social determinants of health and Medicare hospitalisations for ischaemic strokes: a cross-sectional data analysis. Open Heart. 2020;7(1):e001189. doi:10.1136/openhrt-2019-001189
- Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528. doi:10.1161/CIR.0000000000000659
- Tan J, Wang Y. Social integration, social support, and all-cause, cardiovascular disease and cause-specific mortality: a prospective cohort study. Int J Environ Res Public Health. 2019;16(9):1498. doi:10.3390/ijerph16091498
- Nagata JM, Palar K, Gooding HC, Garber AK, Bibbins-Domingo K, Weiser SD. Food insecurity and chronic disease in US young adults: findings from the National Longitudinal Study of Adolescent to Adult Health. J Gen Intern Med. 2019;34(12):2756-2762. doi:10.1007/s11606-019-05317-8
- Suarez JJ, Isakova T, Anderson CA, Boulware LE, Wolf M, Scialla JJ. Food access, chronic kidney disease, and hypertension in the U.S. Am J Prev Med. 2015;49(6):912-920. doi:10.1016/j.amepre.2015.07.017
- Lee BJ, Kim B, Lee K. Air pollution exposure and cardiovascular disease. Toxicol Res. 2014;30(2):71-75. doi:10.5487/TR.2014.30.2.071
- Shaw KM, Theis KA, Self-Brown S, Roblin DW, Barker L. Chronic disease disparities by county economic status and metropolitan classification, behavioral risk factor surveillance system, 2013. Prev Chronic Dis. 2016;13:E119. doi:10.5888/pcd13.160088
- Troxel WM, Matthews KA, Bromberger JT, Sutton-Tyrrell K. Chronic stress burden, discrimination, and subclinical carotid artery disease in African American and Caucasian women. Health Psychol. 2003;22(3):300-309. doi:10.1037/0278-6220.127.116.110