Social Determinants of Health Education Programs: Equipping Future Health Professionals

The increasing recognition of social determinants of health (SDOH) as critical factors influencing health outcomes has underscored the urgency of preparing health professionals to understand and address them effectively. This article explores the importance of SDOH education programs in shaping a more equitable and health-conscious healthcare workforce.

Understanding Social Determinants of Health

Social determinants of health are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These determinants encompass a broad range of factors, including economic stability, education, social and community context, health and healthcare access, and neighborhood environment. The World Health Organization emphasizes that addressing SDOH is fundamental for improving health and reducing long-standing inequities in health, which requires action by all sectors and civil society.

The Imperative for SDOH Education

Preparing the next generation of healthcare professionals to address the social determinants of their patients is crucial. The Liaison Committee on Medical Education, the American College of Graduate Medical Education, and the Accreditation Review Commission on Education for the Physician Assistant require that curricula include education about SDOH. However, when these requirements were introduced, health professions educators lacked guidance or best practices on how to develop a SDOH curriculum.

The National Collaborative for Education to Address the Social Determinants of Health (NCEAS)

Established at Northwestern University’s Feinberg School of Medicine, the National Collaborative for Education to Address the Social Determinants of Health (NCEAS) works to accelerate the spread of innovative approaches to health professions’ education. Since its inception in 2016, NCEAS has worked to advance learners’ ability to identify, understand, and address SDOH, and better prepare the health care workforce to advance health equity. NCEAS is a program funded by the Health Resources and Services Administration whose mission includes studying and disseminating health professions curricula and programs that develop learner competency in addressing SDOH, population health, and promotion of health care equity. Over the past 6 years, the NCEAS team has developed several dissemination venues to help address SDOH in medical education.

The Curriculum Collection: A Digital Platform for SDOH Education

To support the goal of integrating SDOH into health professions education, faculty and staff from NCEAS built a digital platform for health professions educators to access and share curricular work related to SDOH. Launched in 2018, the Curriculum Collection is an indexed database of curricula and assessment materials (including courses, simulations, cases, and experimental learning opportunities) ready for health professions educators to implement. This collection addresses major subject areas of SDOH and is relevant to a broad spectrum of audiences. The Curriculum Collection is currently home to more than 200 resources. This wide array of educational resources focusing on SDOH is indexed and searchable by topic, intended learner type, delivery mode, year published, and other characteristics. The online resource included more than 200 curricula focused on SDOH and additional content related to both SDOH and health equity.

New resources are added to the collection on an ongoing basis after a collaborative review process. Over the past 5 years, the review team has included 8 to 10 health care professionals. Each team member reviews 5 to 10 resources a month using a questionnaire through RedCap (Vanderbilt University) that was created by the group in the early stages of the collection. The NCEAS team members review candidate resources to assess the quality, timeliness, and relevance to 1 or more SDOH topics. Each resource is also annotated with an assessment of its strengths and areas for improvement, and indexed with searchable terms including learner discipline, level, and the specific topic within the SDOH field. Content is of particular relevance to medical, nursing, physician assistant, and dental students, residents, fellows, and clinicians in practice seeking continuing education in this area. Along with reviewing new resources, current activities include re-reviewing existing content to ensure that the posted collection continues to be representative of the NCEAS mission statement, the resources are free from bias, and outdated material is retired. The most viewed resources in the Curriculum Collection are the resources under the SDOH topic of antiracism.

Potential resources have been either curated from existing repositories online (eg, MedEdPORTAL, PubMed) or submitted directly by authors through an online portal.

The Broader Impact of Education on Health

Beyond specific SDOH curricula, education in general plays a significant role in shaping health outcomes. Education gives people the tools they need to lead fulfilling lives, thrive personally, and contribute to their communities. In addition, education makes it more likely a person can access quality healthcare, find employment that pays a living wage, and live in a safe, non-polluted environment - all factors that affect well-being.

Education as a Social Determinant of Health

Education is a powerful social determinant of health. Access to quality education early in life, high school graduation, and a college education can all provide opportunities for people to shift their socioeconomic status, reducing the likelihood of negative health outcomes in return. Because of this, understanding how education impacts the health of communities is vital for public health professionals fighting to end health inequity.

People who have access to quality education throughout their lives tend to stay healthier than people who don’t. Not only does education give individuals a chance at upward mobility, which places them in better financial circumstances to access quality health care, it also keeps them better informed about how to take care of their health. Less education is linked to lower income, which is linked to poorer health. Numerous studies show that people in lower socioeconomic situations experience more obesity, asthma, diabetes, heart disease and other health problems than people in better financial circumstances.

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Ultimately, more highly educated people have greater economic resources to afford things like better housing far away from environmental toxins and expert doctors trained in the most effective techniques.

The Connection Between Education and Health Outcomes

Countless links between education and health show that individuals with higher levels of education live healthier and longer lives than those who are less educated.

Starting from early childhood, research shows links between access to education and better health. Children attending Head Start, an early learning program that prepares young children from low income households for elementary school, for example, will likely lead those children to experience health benefits both during and after their participation in the program. On the other hand, children enrolled in schools lacking in health resources and teacher support tend to experience poorer physical and mental health. Educational opportunities earlier in life have lasting effects on health through adulthood.

Completion of high school can also serve as a health indicator. A college education is associated with even greater health benefits. Research shows that with increasing levels of college education people are less likely to die from cancer and cardiovascular disease. College graduates also report better health compared to high school graduates.

In many ways, the connection between the two is clear cut. Most people find their way to financial stability through education. Greater financial stability allows for increased access to good health insurance and safe housing in unpolluted environments. In turn, access to doctors creates more opportunities for people to gain important information about their health. In addition, education prepares people to analyze information and manage complex problems, critical skills needed to navigate today’s complicated healthcare system.

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Addressing Health Inequities through Education

Many variables within education are linked to health: literacy, high school graduation, and enrollment in higher education each present opportunities to improve education and thereby promote health equity. By researching solutions and initiating programs that address education disparities, public health professionals can create pathways that lead people to healthier lives.

Life expectancy and healthy life expectancy have increased, but unequally. There remain persistent and widening gaps between those with the best and worst health and well-being. Poorer populations systematically experience worse health than richer populations. Such trends within and between countries are unfair, unjust and avoidable.

Other Key Social Determinants of Health

Besides education, several other social determinants of health significantly impact individual and community well-being.

Economic Stability

Economic stability includes elements such as work environment and wages, sufficient money for food and housing, and socioeconomic status. Each of these factors can affect health in different ways.

Studies show that people who can’t buy enough food are more likely to experience chronic diseases and children who face food insecurity are at increased risk for obesity, malnutrition, and developmental problems. When people spend 30% or more of their salaries on housing, they often have little money for other necessities like nutritious food or prescription medications.

Social and Community Context

Social and community context encompasses civic activities, social cohesion, discrimination, and incarceration. These elements can affect health in various ways. For example, people who participate in civic and community activities can make social connections, become more physically fit, and better manage mental health issues like depression.

Structural discrimination, or policies in public and private institutions that disproportionately affect particular groups, can also impact health. Unequal access to housing and health care, or policies that result in disproportionate interactions with the criminal justice system increase psychosocial stress and mental health problems.

Health and Health Care Access

Access to primary health care, a regular source of care that detects and treats diseases and provides preventative services, is an important part of staying well. However, when barriers, such as inadequate health insurance coverage or a shortage of care providers prevent people from getting these services, health suffers.

Health literacy, or the ability to obtain and understand health information, is an important tool. Individuals who understand various health risks and the precautions that can reduce those risks can better safeguard themselves.

Neighborhood and Built Environment

Environmental conditions where people live, access to healthy foods and quality housing, and the absence or presence of violence and crime, all play a significant role in people’s health.

To help prevent obesity, high blood pressure, and diabetes, diets should include fresh fruits and vegetables, whole grains, protein and limited saturated fats. However, living in neighborhoods that lack grocery stores that sell fresh nutritious foods (i.e., food deserts) or lacking the money to purchase these foods puts people at a greater risk for poor health.

People who live in high crime neighborhoods may avoid going outside out of fear for their safety. This lack of physical activity can lead to negative health outcomes.

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