THE SOCIAL DETERMINANTS OF HEALTH STUDY GUIDE LATEST
VERSION; RATED A+
A range of personal, social, economic, and environmental factors contribute to individual and population
health.
For example, people with a quality education, stable employment, safe homes and neighborhoods, and
access to preventive services tend to be healthier throughout their lives.1
Conversely, poor health outcomes are often made worse by the interaction between individuals and
their social and physical environment.
Social determinants are in part responsible for the unequal and avoidable differences in health status
within and between communities.
The selection of Social Determinants as a Leading Health Topic recognizes the critical role of home,
school, workplace, neighborhood, and community in improving health.
The Leading Health Indicators Are:
Students graduating from high school 4 years after starting 9th grade (AH-5.1)
Although education is the Leading Health Indicator for this topic, many of the Healthy People 2020
objectives address social determinants as a means to improve population health.
Health Impact of Social Determinants
Social and physical determinants affect a wide range of health, functioning, and quality of life outcomes.
For example:
-Access to parks and safe sidewalks for walking is associated with physical activity in adults.2
-Education is associated with:
Longer life expectancy
Improved health and quality of life
Health-promoting behaviors like getting regular physical activity, not smoking, and going for routine
checkups and recommended screenings.3
-Discrimination, stigma, or unfair treatment in the workplace can have a profound impact on health;
discrimination can increase blood pressure, heart rate, and stress, as well as undermine self-esteem and
self-efficacy.3
-Family and community rejection, including bullying, of lesbian, gay, bisexual, and transgender youth can
have serious and long-term health impacts including depression, use of illegal drugs, and suicidal
behavior.4
,-Places where people live and eat affect their diet. More than 23 million people, including 6.5 million
children, live in "food deserts"—neighborhoods that lack access to stores where affordable, healthy
food is readily available (such as full-service supermarkets and grocery stores).5
Social Determinants Across the Life Stages
From infancy through old age, the conditions in the social and physical environments in which people
are born, live, work, and age can have a significant influence on health outcomes.
Children
Early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong
health, learning, and well-being.
A history of exposure to adverse experiences in childhood, including exposure to violence and
maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky
sexual behavior, as well as health problems such as obesity, diabetes, heart disease, sexually transmitted
diseases, and attempted suicide.6
Features of the built environment, such as exposure to lead-based paint hazards and pests, negatively
affect the health and development of young children.
Adolescents
Because they are in developmental transition, adolescents and young adults are particularly sensitive to
environmental influences.
Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues,
can either support or challenge young people's health and well-being.
Addressing young people's positive development facilitates their adoption of healthy behaviors and
helps to ensure a healthy and productive future adult population.
Adolescents who grow up in neighborhoods characterized by poverty are more likely to be victims of
violence; use tobacco, alcohol, and other substances; become obese; and engage in risky sexual
behavior.7
Adults
Access to and availability of healthier foods can help adults follow healthful diets.
For example, better access to retail venues that sell healthier options may have a positive impact on a
person's diet.
These venues may be less available in low-income or rural neighborhoods.
Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary
,work are realities of the modern workplace and are increasingly affecting the health and lives of U.S.
adults.
Research has shown that workers experiencing these stressors are at higher risk of injuries, heart
disease, and digestive disorders.8
Older Adults
Availability of community-based resources and transportation options for older adults can positively
affect health status.
Studies have shown that increased levels of social support are associated with a lower risk for physical
disease, mental illness, and death.9
Disparities and Social Determinants
Race and ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic
location all contribute to an individual's ability to achieve good health.
It is important to recognize the impact that social determinants have on health outcomes of specific
populations.
Social determinants are often a strong predictor of health disparities. For example:
-In 2007 to 2008, the Asian or Pacific Islander population had the highest rate of high school graduation
among racial and ethnic groups, with 91.4% of students attending public schools graduating with a
diploma 4 years after starting 9th grade compared to rates among non-Hispanic white (81.0%),
American Indian or Alaska Native (64.2%), Hispanic (63.5%), and non-Hispanic black (61.5%) populations.
-According to the National Assessment of Adult Literacy, African American, Hispanic, and American
Indian or Alaska Native adults were significantly more likely to have below basic health literacy
compared to their white and Asian or Pacific Islander counterparts. Hispanic adults had the lowest
average health literacy score compared to adults in other racial and ethnic groups.10
-In 2007, African Americans and Hispanics were more likely to be unemployed compared to their white
counterparts. Further, adults with less than a high school education were 3 times more likely to be
unemployed than those with a bachelor's degree.11
-Low socioeconomic status is associated with an increased risk for many diseases, including
cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer as well as for
frequent mental distress.11
-Low-income minorities spend more time traveling to work and other daily destinations than do low-
income whites because they have fewer private vehicles and use public transit and car pools more
frequently.11
Students who graduate with a regular diploma 4 years after starting 9th grade (AH-5.1)
, Where We've Been and Where We're Going
The on-time graduation rate in public schools, defined by the percentage of students awarded a high
school diploma 4 years after starting 9th grade, increased by 4%, from 79% for school-year 2010-11 to
82% for 2013-14, moving toward the HP2020 target of 87%.
For the 2013-14 school year, Asian or Pacific Islander, non-Hispanic students had the highest rate of on-
time graduation.
On-Time High School Graduation (AH-5.1)
Healthy People 2020 objective AH-5.1 tracks the on-time graduation rate from public high schools.
HP2020 Baseline: In the 2010-11 school year, 79% of students attending public schools graduated with a
regular diploma 4 years after starting 9th grade.
HP2020 Target: 87%, a 10% improvement over the baseline, which was established for the 2010-11
school year.
The on-time graduation rate increased from 79% in the 2010-11 school year to 82% in the 2013-14
school year.
On-time high school graduation rates varied among racial and ethnic groups in the 2013-14 school year
89% asian or pacific islander, non-hispanic
87% white, non-hispanic
76% hispanic
72% black, non-hispanic
70% american indian or alaska native, non-hispanic
Among racial and ethnic groups, the Asian or Pacific Islander, non-Hispanic population had the highest
(best) rate of on-time graduation, 89% for the 2013-14 school year.
Rates for other subgroups were:
White, non-Hispanic: 87%
Hispanic: 76%
Black, non-Hispanic: 72%
American Indian or Alaska Native, non-Hispanic: 70%
Leading Health Indicators (LHI)
https://www.healthypeople.gov/2020/leading-health-indicators/Leading-Health-Indicators-
Development-and-Framework
Leading Health Indicators Development and Selection Process
VERSION; RATED A+
A range of personal, social, economic, and environmental factors contribute to individual and population
health.
For example, people with a quality education, stable employment, safe homes and neighborhoods, and
access to preventive services tend to be healthier throughout their lives.1
Conversely, poor health outcomes are often made worse by the interaction between individuals and
their social and physical environment.
Social determinants are in part responsible for the unequal and avoidable differences in health status
within and between communities.
The selection of Social Determinants as a Leading Health Topic recognizes the critical role of home,
school, workplace, neighborhood, and community in improving health.
The Leading Health Indicators Are:
Students graduating from high school 4 years after starting 9th grade (AH-5.1)
Although education is the Leading Health Indicator for this topic, many of the Healthy People 2020
objectives address social determinants as a means to improve population health.
Health Impact of Social Determinants
Social and physical determinants affect a wide range of health, functioning, and quality of life outcomes.
For example:
-Access to parks and safe sidewalks for walking is associated with physical activity in adults.2
-Education is associated with:
Longer life expectancy
Improved health and quality of life
Health-promoting behaviors like getting regular physical activity, not smoking, and going for routine
checkups and recommended screenings.3
-Discrimination, stigma, or unfair treatment in the workplace can have a profound impact on health;
discrimination can increase blood pressure, heart rate, and stress, as well as undermine self-esteem and
self-efficacy.3
-Family and community rejection, including bullying, of lesbian, gay, bisexual, and transgender youth can
have serious and long-term health impacts including depression, use of illegal drugs, and suicidal
behavior.4
,-Places where people live and eat affect their diet. More than 23 million people, including 6.5 million
children, live in "food deserts"—neighborhoods that lack access to stores where affordable, healthy
food is readily available (such as full-service supermarkets and grocery stores).5
Social Determinants Across the Life Stages
From infancy through old age, the conditions in the social and physical environments in which people
are born, live, work, and age can have a significant influence on health outcomes.
Children
Early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong
health, learning, and well-being.
A history of exposure to adverse experiences in childhood, including exposure to violence and
maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky
sexual behavior, as well as health problems such as obesity, diabetes, heart disease, sexually transmitted
diseases, and attempted suicide.6
Features of the built environment, such as exposure to lead-based paint hazards and pests, negatively
affect the health and development of young children.
Adolescents
Because they are in developmental transition, adolescents and young adults are particularly sensitive to
environmental influences.
Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues,
can either support or challenge young people's health and well-being.
Addressing young people's positive development facilitates their adoption of healthy behaviors and
helps to ensure a healthy and productive future adult population.
Adolescents who grow up in neighborhoods characterized by poverty are more likely to be victims of
violence; use tobacco, alcohol, and other substances; become obese; and engage in risky sexual
behavior.7
Adults
Access to and availability of healthier foods can help adults follow healthful diets.
For example, better access to retail venues that sell healthier options may have a positive impact on a
person's diet.
These venues may be less available in low-income or rural neighborhoods.
Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary
,work are realities of the modern workplace and are increasingly affecting the health and lives of U.S.
adults.
Research has shown that workers experiencing these stressors are at higher risk of injuries, heart
disease, and digestive disorders.8
Older Adults
Availability of community-based resources and transportation options for older adults can positively
affect health status.
Studies have shown that increased levels of social support are associated with a lower risk for physical
disease, mental illness, and death.9
Disparities and Social Determinants
Race and ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic
location all contribute to an individual's ability to achieve good health.
It is important to recognize the impact that social determinants have on health outcomes of specific
populations.
Social determinants are often a strong predictor of health disparities. For example:
-In 2007 to 2008, the Asian or Pacific Islander population had the highest rate of high school graduation
among racial and ethnic groups, with 91.4% of students attending public schools graduating with a
diploma 4 years after starting 9th grade compared to rates among non-Hispanic white (81.0%),
American Indian or Alaska Native (64.2%), Hispanic (63.5%), and non-Hispanic black (61.5%) populations.
-According to the National Assessment of Adult Literacy, African American, Hispanic, and American
Indian or Alaska Native adults were significantly more likely to have below basic health literacy
compared to their white and Asian or Pacific Islander counterparts. Hispanic adults had the lowest
average health literacy score compared to adults in other racial and ethnic groups.10
-In 2007, African Americans and Hispanics were more likely to be unemployed compared to their white
counterparts. Further, adults with less than a high school education were 3 times more likely to be
unemployed than those with a bachelor's degree.11
-Low socioeconomic status is associated with an increased risk for many diseases, including
cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer as well as for
frequent mental distress.11
-Low-income minorities spend more time traveling to work and other daily destinations than do low-
income whites because they have fewer private vehicles and use public transit and car pools more
frequently.11
Students who graduate with a regular diploma 4 years after starting 9th grade (AH-5.1)
, Where We've Been and Where We're Going
The on-time graduation rate in public schools, defined by the percentage of students awarded a high
school diploma 4 years after starting 9th grade, increased by 4%, from 79% for school-year 2010-11 to
82% for 2013-14, moving toward the HP2020 target of 87%.
For the 2013-14 school year, Asian or Pacific Islander, non-Hispanic students had the highest rate of on-
time graduation.
On-Time High School Graduation (AH-5.1)
Healthy People 2020 objective AH-5.1 tracks the on-time graduation rate from public high schools.
HP2020 Baseline: In the 2010-11 school year, 79% of students attending public schools graduated with a
regular diploma 4 years after starting 9th grade.
HP2020 Target: 87%, a 10% improvement over the baseline, which was established for the 2010-11
school year.
The on-time graduation rate increased from 79% in the 2010-11 school year to 82% in the 2013-14
school year.
On-time high school graduation rates varied among racial and ethnic groups in the 2013-14 school year
89% asian or pacific islander, non-hispanic
87% white, non-hispanic
76% hispanic
72% black, non-hispanic
70% american indian or alaska native, non-hispanic
Among racial and ethnic groups, the Asian or Pacific Islander, non-Hispanic population had the highest
(best) rate of on-time graduation, 89% for the 2013-14 school year.
Rates for other subgroups were:
White, non-Hispanic: 87%
Hispanic: 76%
Black, non-Hispanic: 72%
American Indian or Alaska Native, non-Hispanic: 70%
Leading Health Indicators (LHI)
https://www.healthypeople.gov/2020/leading-health-indicators/Leading-Health-Indicators-
Development-and-Framework
Leading Health Indicators Development and Selection Process
