What Are Social Determinants of Health?

Health is strongly impacted by the conditions in which people grow, learn, work, and live. Consider, for example, the health implications of trying to exercise in a neighborhood with no sidewalks, being unable to read a prescription drug label, or worrying that your food would run out before your next paycheck. These conditions are often referred to as Social Determinants of Health (SDOH).

Some of the most common SDOH assessed in relationship to health outcomes are income, educational attainment, employment status, and access to food, housing, and transportation. Although non-clinical in nature, there is strong interest in exploring the influence of population-level social conditions on health outcomes and healthcare spending because of the rising cost of healthcare, recent changes in reimbursement policy, and the shift towards value-based care.

Low-income populations often have individuals with unmet social needs who are more likely to have difficulties in managing chronic health conditions, including their medications. Overall, only about 50% of people take their medications as prescribed, but those struggling with housing instability, food insecurity, lack of transportation, unemployment, personal safety issues, and other social needs often find it even harder to be adherent. Those struggling to manage their medications in the face of challenging circumstances need tailored care; however, strategies to address these non-clinical needs by pharmacists are less established.

Only a handful of resources exist detailing how pharmacists can integrate principles of SDOH into patient care, spearheaded by The Center for Healthcare Strategies (CHS). The CHS has worked to bridge this resource gap through their Community Management of Medication Complexity Innovation Lab, which offers strategies on how to improve medication management services for people with complex social needs by hosting webinars, reports, blogs, and stakeholder profiles.

Screening for SDOH

Recently, a research team at the Center for Medication Optimization has created a validated screening toolkit that compiles a host of publicly available, validated SDOH screening questions. These validated screening questions have been tested to produce consistent and true results that correctly identify the right people. This toolkit can help healthcare providers identify unmet needs related to hunger, education, culture, transportation, and many other topics that might impact a person’s ability to focus whole-heartedly on their well being. 



Using validated screening questions is important for ensuring the accuracy of survey results. Non-validated questions can be dangerous as they may lead to the over- or under-identification of the target population. In other words, non-validated screening questions can lead to the wrong people being identified as in need, resulting in the use of resources on those who don’t need them at the expense of those who do. Therefore, using validated questions helps to make sure organizations are identifying and using their resources on the right people – those who truly have unmet social needs.

This toolkit will also be extremely useful for those wanting to build their own screening surveys. Healthcare providers can use this information to target their limited resources and programs at those who can benefit most, ultimately leading to better health outcomes and more satisfied patients.