Join our efforts to put an end to health inequities and harmful social determinants of health (SDOH).
Join our efforts to put an end to health inequities and harmful social determinants of health (SDOH).
Join our efforts to put an end to health inequities and harmful social determinants of health (SDOH).
Join our efforts to put an end to health inequities and harmful social determinants of health (SDOH).
Discover eight principles about the mechanisms of social determinants of health that can inform your work.
Explore our framework for nurse-led programs that can help mitigate the harmful social determinants of health.
Stay updated on the Duke University School of Nursing’s latest efforts to transform health care.
The United States faces an increasing burden of disease largely driven by stark health inequities—systematic, unfair, and avoidable health differences between segments of the population.
If left unaddressed, the growing cost of health inequities in the United States is unsustainable and threatens the future health and economic wellbeing of the country.
If efforts to reduce health inequity are to be successful, new thinking is needed to design and implement more effective programs that can mitigate the harmful social determinants of health.
In an effort to shift the paradigm, the Center for Latino Adolescent and Family Health (CLAFH) at the Duke University School of Nursing has synthesized the existing research on social determinants of health. Our team identified eight key SDOH principles that should be considered when designing and implementing programs to mitigate harmful social determinants of health.
A review of landmark research identifies eight key principles about the mechanisms of social determinants of health.
After clicking each icon to learn more about the eight principles, scroll down to discover how they inform the Duke University School of Nursing (DUSON) Center for Latino Adolescent and Family Health’s (CLAFH) framework for mitigating harmful SDOH.
Enter your email address and we will send you a link to download a copy of the Duke University School of Nursing’s latest presentation.
American Hospital Association. Health for life focus on wellness. 2007. Accessed November 17, 2022. health life focus wellness.
Boersma P, Black LI, Ward BW, Prevalence of multiple chronic conditions among US adults, 2018. Prev Chronic Dis. 2020;17;200130. doi:http://dx.doi.org/10.5888/pcd17.200130.
National Center for Chronic Disease Prevention and Health Promotion. Chronic diseases in America. cdc.gov. Last reviewed October 7, 2022. Accessed November 17, 2022. cdc.gov/chronicdisease.
National Center for Health Statistics. Life tables, 2001-2021. cdc.gov. Page reviewed September 7, 2022. Accessed November 17, 2022. cdc.gov/~/life_tables.
Medina L, Sabo S, Vespa J. Living longer: Historical and projected life expectancy in the United States, 1960 to 2060. U.S. Census Bureau. 2020;25-1145. census.gov Accessed November 17, 2022.
OECD. Health at a glance. Oecd-ilibrary.org. Accessed November 17, 2022. https://doi.org/10.1787/19991312.
Rothstein B, Uslaner EM. Equality, corruption, and social trust. World Politics. 2005;58:41-72. gvptsites.umd.edu/~/rothsteinuslanerworldpolitics.pdf. Accessed November 17, 2022.
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Umberson D, Olson JS, Crosnoe R, et al.. Death of family members as an overlooked source of racial disadvantage in the United States. Proc Natl Acad Sci. 2017;114(5). doi: https://doi.org/10.1073/pnas.1605599114.
Healthy People 2030. Social cohesion. Health.gov. Accessed November 17, 2022. health.gov/~/social-cohesion.
Dhar A, Bhatt J, Batra N, Rush B, Gerhardt W, Davis A. US health care can’t afford health inequities. Deloitte. Published June 22, 2022. Accessed November 17, 2022. deloitte.com/~/economic-cost-of-health-disparities.
Magnan S. Social determinants of health 101 for health care: Five plus five. National Academy of Medicine. 2017. doi: https://doi.org/10.31478/201710c.
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Healthy People 2030. Social determinants of health. health.gov. Accessed November 17, 2022. health.gov/~/social-determinants-health.
Thimm-Kaiser M, Benzekri A., Guilamo-Ramos V. Conceptualizing the mechanisms of social determinants of health: A heuristic framework to inform future directions for mitigation. 2022. (under review).
About SDOH. Centers for Disease Control and Prevention. Page reviewed June 28, 2021. Accessed November 17, 2022. https://www.cdc.gov/socialdeterminants/about.html.
Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. Am J Prev Med. 2016;50(2):129-135. https://doi.org/10.1016/j.amepre.2015.08.024.
Magnan S. Social determinants of health 101 for health care: Five plus five. National Academy of Medicine. 2017. doi: https://doi.org/10.31478/201710c.
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Lapehn S, Paquette AG. The placental epigenome as a molecular link between prenatal exposures and fetal health outcomes through the DOHaD hypothesis. Curr Environ Health Rep. 2022;9(3): 490-501. doi:https://doi.org/10.1007/s40572-022-00354-8
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Health inequities are the biological expression of inequitable social processes, also known as social injustice.
Successful efforts to reduce health inequities mitigate the ways in which unjust social processes such as racism, classism, sexism, xenophobia, and homophobia, etc., shape the health of individuals and communities.
Communities or populations affected by harmful SDOH tend to experience multiple co-occurring health inequities that further exacerbate each other.
Because co-occurring health inequities interact, one health inequity can seldomly be addressed in isolation. One important element of mitigating the impact of harmful SDOH is to understand and address the health of a community or population comprehensively and holistically.
The health impact of harmful SDOH can be transmitted across multiple generations (both through social and biological mechanisms).
Focusing on the family unit as a primary context for shaping individual health outcomes represents an underrecognized opportunity for health interventions, including for mitigating the impact of harmful SDOH.
The social conditions we experience over the course of life result in changes to our biology.
SDOH can trigger and sustain biological changes in people’s bodies (epigenetic, brain, immune, hormonal, microbiome, etc.) that may contribute to a person’s chances of negative health outcomes.
The health effects of SDOH accumulate over the course of a person’s lifetime.
The social, economic, psychological, environmental, and other SDOH influences that an individual experiences early in life continue to impact health outcomes later in life, which is why mitigating harmful SDOH influences in childhood and adolescence is particularly important.
Harmful SDOH do not always result in negative health outcomes. There are structural, institutional, and individual factors that can offset the impact of harmful SDOH.
Identifying and understanding the factors that enable individuals and communities to thrive despite experiencing harmful SDOH is a major opportunity to enhance current efforts to reduce health inequities.
Our health outcomes are largely shaped by the context in which we are embedded, not solely by our genetics or behavior.
Efforts to reduce health inequities need to move beyond individual-level interventions and adopt mitigation measures tailored to the unique health risk and protective factors in a given community context.
Health inequities are the result of structural causes, not of individual or community characteristics.
In order to be successful, efforts to reduce health inequities have to recognize and mitigate the ways in which structural factors, such as income and educational inequality, quality of available housing, accessibility and quality of health care services, etc., shape the health of individuals and communities.
Enter your email address and we will send you a link to download a copy of the Duke University School of Nursing’s latest research paper.
Dhar A, Bhatt J, Batra N, Rush B, Gerhardt W, Davis A. US health care can’t afford health inequities. Deloitte. Published June 22, 2022. Accessed November 17, 2022.
Thimm-Kaiser M, Benzekri A., Guilamo-Ramos V. Conceptualizing the mechanisms of social determinants of health: A heuristic framework to inform future directions for mitigation. 2022. (under review).
