The 5 Social Determinants of Health and why they matter

Researchers have found that medical care accounts for only 20% of a child's health outcomes. As much as 80% of health factors are influenced by social determinants, the conditions in which children are born, learn, live, work, play, worship and age. Where children live, work, go to school, and socialize, as well as the conditions of these environments, all play a major role in in students' mental and physical health. Many social determinants are factors that an individual can not control, such as pollution, neighborhood violence, community green space, or healthy food availability.

At Hazel, addressing social determinants of health (SDoH) is a key component of our mission. Hazel was founded on the belief that the best health care addresses more than just physical or mental concerns, but also the social and environmental context surrounding a child's health and well-being.

Social determinants are grouped into 5 areas:

1. Education access and quality - the link between a child's access to quality education and their health, such as: school quality, access to tutors and guidance counselors, school safety
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2. Health care access and quality - the link between a child's access to quality health care and their health, such as: medical coverage/insurance, access to preventive and acute medical care, health literacy
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3. Economic stability - the link between a child's financial situation and their health outcomes, such as: poverty, income, employment, housing stability, food security
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4. Neighborhood and built environment - the link between the environment a child lives or works in, and their health, such as: neighborhood safety, crime and violence, pollution (water, air, noise), transportation, parks, nutritious food, physical activity opportunities
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5. Social and community context - the link between a child’s relationships, social context, and their health, such as: incarceration, discrimination, workplace conditions, and having access to supportive relationships

In order to deliver proactive care that helps improve health outcomes, health care providers should be aware of the social determinants impacting those they care for. They must consider how the social determinants influence how a person engages with their health, as well as their health outcomes. For example, if a child and their family do not have access to a grocery store with healthy foods, they may face more challenges to maintaining a nutritious diet, increasing their risk of facing health conditions like heart disease, diabetes, and obesity. Someone who does not have access to transportation may be less able to access health care services, which can result in lower health literacy or missed diagnoses.

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Addressing Social Determinants

At Hazel, we understand that addressing social determinants can help ensure access to high quality care and improve patient health. We believe that for children across the country to experience improved health outcomes, we must consider the conditions in which they live and learn, and we must take steps to address challenges in their environment that contribute to poor health outcomes.

Let’s dive a bit deeper into each determinant, and examine broadly how each should be considered, and specifically, how Hazel addresses each social determinant.

Determinant 1: Access to Quality Education

There is a strong association between health outcomes and an individual’s education level. Individuals who have access to education throughout life are more likely to be and remain healthy. Across all racial and ethnic groups, adults with lower education attainment are more likely to report worse health outcomes. Children who have access to quality education throughout their development have better health outcomes, and are more likely to experience upward mobility. Later in life, these children are more likely to access quality, consistent health care, find employment that pays a decent wage, and live in a safe, clean environment.

Programs that help children do well (and stay) in school, and programs that help families pay for colleges or learning support, are examples of ways to help address this social determinant. Investing in education can equate to investing in health, and vice versa.

How Hazel Helps

After a Hazel in-school visit, 90% of students are able to return to class, as opposed to being sent home. This saves 3 hours of instructional time on average, and helps reduce chronic absenteeism and maximize learning and classroom time. Hazel also shares health resources and tips with students and families because we understand that health literacy is essential for good health.

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Determinant 2: Improving Access to Quality Health Care

In the United States, 28 million people are living without health insurance. Many children without health insurance lack access to a primary care provider (PCP). These individuals often do not have the financial means to make vital purchases for health, such as medications, diagnostic screenings, and often, surgery and other treatments.

Many families live far away from a hospital or clinic, and/or do not have the means to travel to these facilities. Others struggle with health literacy and access to accurate information concerning their health.

Interventions that increase access to healthcare providers and improve communication can help people get the care they need. Transportation assistance, neighborhood health screenings, telehealth services, reduction in emergency department wait times and insurance coverage education, are examples of programs that can help improve access to quality health care.

Remote solutions, such as telehealth, are an excellent way to bridge the barrier of access as they can remove what can often be an insurmountable challenge of transportation — enabling people to receive care who otherwise likely would not be able to (or would struggle to do so). Telehealth increases convenience, resulting in fewer work days missed for parents/guardians, and less missed class for kids.

How Hazel Helps

Hazel’s goal is to improve access to physical and mental health care. By bringing healthcare services directly into the school and home setting via video visits, children are able to access care where and when they need it. Hazel connects students with a provider (doctors, physician associates, nurse practitioners, and therapists) whether they are at home or at school. This enables the student to receive the care they need where they are. After a Hazel visit, Hazel’s team of Family Resource Managers helps the patient and family get connected with the long term care they need within their community.

Hazel is available to all children, and regardless of insurance status. This ensures all children have equal access to the care they need.

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Determinant 3: Economic Stability

Family economic stability is a key predictor of good student health. Today, around 37 million people in the United States live in poverty and more than 16% of children under 18 years old live below the poverty line. Many people can’t afford healthy foods, health care and housing.

Families with steady employment and a livable wage are more likely to be healthy. However, many people have trouble finding and keeping a job, and others don’t earn enough to afford the things they need to achieve good health.

Employment programs, career counseling, high quality (low cost) childcare and housing assistance are examples of programs that help to foster economic stability.

How Hazel Helps

Hazel serves all students, regardless of their financial or insurance status. This means that all children, those who have insurance, and those who don’t, can benefit from the service.

Hazel helps students remain in school, and helps parents remain at work (parents don’t have to take off work to take their child to the doctor, resulting in missed pay). Hazel’s Family Resource Managers help connect families to community resources such as food services and housing programs.

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Determinant 4: Social and Community Context

Many social determinants are factors that an individual cannot control, for example unsafe neighborhoods, discrimination, or the capacity to pay for basic necessities.

Programs that help families get needed social and community support (including access to health care providers who speak their language and with whom they can connect culturally) are critical for improving health. Examples include mentorship programs, support to families with an incarcerated family member, bullying prevention programs, and language translation services.

How Hazel Helps

At Hazel, over 50% of providers identify as persons of color (PoC), and 40% of Hazel providers are bilingual, speaking more than 8 languages. Hazel providers reflect the communities they serve and are able to identify with the backgrounds and circumstances of their patients, and their patients' families and communities.

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Determinant 5: Neighborhood and Built Environment

The neighborhood a person lives in has a major impact on their health. Factors like high rates of violence, contaminated water, unsafe schools, low air quality, noise pollution, and heavy traffic can introduce risks to a person’s health and safety.

At the community, state, and national level changes can be made to improve public environments and overall health. For example, bike and pedestrian lanes, community gardens, and trash pick-up initiatives are all examples of programs that improve living conditions and increase safety, resulting in healthier communities.

How Hazel Helps

Hazel eliminates the barrier of travel by providing care where the child is—at school or at home, in a safe, culturally competent setting. Additionally, Hazel therapy services help students navigate the social and emotional challenges they may be dealing with at home, school, or in their communities, taking into account conditions such as asthma and allergies.

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Social Determinants Profoundly Impact Health

At Hazel, addressing the social determinants means:

• Providing culturally competent health care services (diverse, multilingual providers that reflect the communities we serve)
• Promoting health education and literacy
• Meeting students where they are (at school or at home) with telehealth
• Building relationships between families and community resources and services
• Working in partnership with the school, community, family, and student

Healthy children enjoy a combination of physical, mental, and social well-being — three factors of health that all influence one another. Where a child is born, lives and goes to school influences the opportunities they have to achieve good physical and mental health. A healthy future and a healthy environment go hand-in-hand.