A new framework
for mitigating harmful SDOH

The DUSON/CLAFH framework serves as a roadmap for educators, practitioners, researchers, policymakers and other stakeholders designing programs to mitigate harmful SDOH and bolster strength-based resilience factors that set communities up to thrive despite structural adversity.
Health Inequality
Health inequity: A systematic, unfair, and avoidable health difference between segments of the population.
Social determinants of health
Social determinants of health: 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 and health outcomes.
Social determinants of health capital
Social determinants of health capital: Socially allotted resources and opportunities that affect health outcomes (e.g., income, educational attainment, quality of housing, accessibility and quality of available healthcare, etc.).
Social determinants of health processes
Social determinants of health processes: Social factors shaping the interactions between persons, groups, institutions, commercial interests or systems that affect health outcomes (e.g., policies, business practices, norms, racism, sexism, classism, xenophobia, homophobia, etc.).
Exposure: The subjection to a health risk or protective factor (exposure is environmental or behavioral).
Susceptibility: The likelihood of morbidity/mortality given the exposure to a health risk factor (susceptibility is biological).
Resilience: The factors that enable individuals, institutions, or communities/populations to thrive in the context of adversity.
Family Context

Family Context: The family represents a primary context where the depicted SDOH mechanisms manifest, and where opportunities for mitigation exist.

Micro, Meso, Macro

Micro, Meso, Macro: Each of the depicted constructs and relationships can be conceptualized as micro (individual level), meso (institutional level), and macro (structural level) influences, or a combination thereof.

Life Course

Life Course: The impact of the depicted SDOH mechanisms is cumulative over the course of an individual’s life.


Enter your email address and we will send you a link to download our latest SDOH research papers.

Download Email Catcher - Research Papers
Tick to confirm your request

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. Milbank Q. 2023;101(2):0416.

SDOH are usually grouped into five broad, static domains.


Education Access
and Quality

Health Care Access
and Quality

Neighborhood and
Built Environment

Social and
Community Context

Share with friends