Social Risk and Social Needs
- Name and explain the five pillars of Social Determinants of Health (SDOH).
- Assess how each pillar can positively or negatively impact health.
- Identify resources that can help with each pillar.
Why social factors matter
Having a health condition is difficult for anyone. When you add the challenges of poor access to healthcare and the negative effects of discrimination, poverty, and dangerous environments, it becomes almost impossible to manage.
Typical doctor's appointments usually don't address these issues, but CHWs can help bridge the gap. They understand the factors that affect a person's health — the environment they live in, the social support they have — and they can help address those social needs. They also focus on the positive aspects of a person's life that can help protect their health.
This lesson covers the social factors that determine health (SDOH) and identifies ways CHWs can help patients meet needs related to each.
What we mean by SDOH
Social determinants of health (SDOH) are the conditions in which we are born, live, learn, work, play, worship, and age. They affect our health, how well we function, and our overall quality of life — and they can put us at risk for certain health problems. Feeling safe and having social connections play a role in well-being too. These determinants drive the health disparities we see between communities.
The 5 pillars
- Economic Stability
- Access to Education and Quality of Education
- Access to Healthcare and Quality of Healthcare
- Neighborhood and Physical Environment
- Social and Community Context
More than 60 million Americans experience devastating one-two punches to their health — they have inadequate access to basic health care while also enduring the effects of discrimination, poverty, and dangerous environments that accelerate higher rates of illness.
Pillar 1: Economic Stability
Economic stability is about being able to access the things we need — food, housing, healthcare. The components are poverty, employment, food security, and stable housing. All of them affect health.
What economic stability looks like
Secure employment and income
Steady wages, reliable hours, and benefits.
Why income matters
Higher income provides the basics — nutritious food, safe housing, recreation. It makes medical care easier to afford. Health insurance helps, but even when accounting for it, income still impacts health.
Higher income is linked to healthier lifestyles (less tobacco use, more physical activity). Even controlling for risky behaviors like smoking, higher-income people tend to have better health.
Resources for economic instability
Pillar 2: Education Access & Quality
Education affects health. We measure education by high school graduation rates, enrollment in higher education or vocational training, language and literacy skills, and early childhood education.
High school graduation rates by race/ethnicity (2019-2020, US)
High school graduation rates by race/ethnicity (2019-2020, US)
Source: National Center for Education Statistics
Education and life expectancy
Education correlates with longer life expectancy. On average, high school completion adds approximately 5 years to a 25-year-old's life expectancy.
Education and unemployment
Education affects employment. Average unemployment rates over 30 years (1992-2022) show consistently higher unemployment for those with less education, regardless of the overall economy.
Chronic unemployment or underemployment increases stress and risk for chronic disease (heart disease, diabetes). Education also influences income — less than high school often means low-wage jobs, fewer benefits, and more occupational injury risk.
Education resources
Programs such as 'Early Childhood Education' programs provide many important services to young children as well as their families. This includes child health and development assessments, early education and care, helpful community resources etc. ECE programs can become a vital part of a child's life within the first five years while they are still developing their social and emotional skills.
A patient mentions they were recently laid off, are behind on medical bills, and can no longer afford healthy groceries. Which SDOH pillar best describes this set of needs?
Pillar 3: Health Care Access & Quality
Health care access and quality is the extent to which people have equitable, affordable, and available access to needed healthcare services. It includes physical access, affordability, and other factors. This is a crucial SDOH because it directly impacts health and how patients interact with the healthcare system.
Common challenges in access
- Lack of coverage — no insurance, or no nearby providers accepting their insurance
- Long waiting lists for specific care (rheumatology, psychotherapy)
- High patient-to-provider ratios, which lead to lower-quality care
- Lack of cultural competence — providers without a language match or appropriate cultural training
- Lack of culturally relevant resources (e.g., food pantries offering Halal options)
Pillar 4: Neighborhood & Physical Environment
Where a person lives directly affects their health, well-being, and ability to get healthcare.
Four factors
Factors in the physical environment
Housing Stability
Secure, safe, affordable living situations vs. crowded, unsanitary, unstable ones.
Housing Stability
Housing stability means a secure living situation. Housing instability can take many forms:
- Crowded housing
- Poor sanitation, heating, or cooling conditions
- Compromised structural integrity
- Exposure to allergens or pests
- Unstable access to housing or struggling with high rent
- Couch surfing or experiencing homelessness
Affordable housing resources
Energy assistance resources
Transportation Barriers
Transportation is crucial for accessing healthcare and other resources. Barriers include limited public transportation in underserved areas, overcrowding and disrepair of roads and stations, high fares and personal vehicle expenses, lack of a personal vehicle or access through family and friends, long travel distances, inconvenient schedules, budget cuts to transit, driver's license requirements, and mobility issues. CHWs can help individuals navigate local transportation options.
Physical Safety
Crime and violence are significant public health concerns. Violence causes premature death and non-fatal injuries — physical pain and emotional distress — experienced through victimization, witnessing, or hearing about it.
Feeling less safe due to crime is linked to higher body weight and increased obesity, because it deters outdoor physical activity. Violence affects mental health directly (a traumatic experience) and indirectly (fear hinders outdoor activities beneficial for well-being). Community violence is commonly linked to economic well-being — lower-income neighborhoods have higher crime rates.
Access to Food
Food insecurity (USDA definition) is limited availability or uncertainty in acquiring nutritionally adequate and safe food in socially acceptable ways.
Health effects of food insecurity
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Hunger directly affects thinking and functioning, and a limited safe or balanced diet increases illness risk. Many vulnerable, low-income neighborhoods lack sufficient grocery stores, so high-calorie, high-carb food becomes prevalent. Chronic food insecurity contributes to obesity and diabetes as households substitute cheaper, less nutritious options. Storage and prep matter too — refrigeration, kitchen access, and physical ability (arthritis, carpal tunnel) all affect what's feasible.
Food insecurity resources
Pillar 5: Community & Social Context
How individuals relate to family, friends, coworkers, and community greatly affects their health. Challenges they can't control — unsafe neighborhoods, discrimination, struggling with necessities — harm health and sense of safety over time. Supportive relationships and community connections protect against these effects.
Social isolation vs. loneliness
Social isolation vs. loneliness
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Barriers to social connection
Often people lack social support — they live alone, the people they live with are busy, or family caregivers are too worn out to give support. Discrimination because of health, race, or gender identity, or language and cultural differences, also isolates people.
How other SDOHs affect isolation
How other SDOHs affect isolation
Physical Environment
Living in a small town, a dangerous neighborhood, or far from family can make seeing loved ones hard.
Health situations also affect isolation — people with chronic conditions may feel depressed or anxious, or turn to substances, leading to isolating or pushing others away. Major life events like moving, divorce, or retiring increase loneliness and the need for connection.
Social supports as protective
Spending time doing things you enjoy with others makes you happier, helps you live longer, and gives a sense of purpose. Strong friendships and family bonds keep us healthy — practical support (rides, post-op help, doctor's appointments, medication reminders) plus emotional support during tough times.
Resources: social isolation and loneliness
Match each scenario to its SDOH pillar.
🌟 Lesson takeaways
Social Determinants of Health are the conditions outside the medical system that shape health outcomes — Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Physical Environment, and Social and Community Context. We explored the challenges presented by each pillar and examples of resources you can use to help individuals address them. CHWs are uniquely positioned in social care because they build relationships, understand the social factors affecting health, and help patients find and use the resources they need.
At the end of this module, you'll join a live discussion with your cohort and an instructor. Great work — we'll see you there!