Healthmaking in the past: Using the social determinants of health in paleopathology.

Social determinants of racial health inequities

Bipolar disorder, socioeconomic deprivation, and social isolation are major risk factors for suicide. The interpersonal theory of suicide (IPTS) posits perceived burdensomeness and thwarted belongingness as proximal causes of suicidal thoughts and behaviors, while the social determinants of health (SDOH) framework highlights distal socioeconomic factors. Studies of suicidality in bipolar disorder have used the IPTS and the SDOH framework, but few have integrated them to explore connections between distal and proximal factors. This study examined perceived burdensomeness and thwarted belongingness as mediators of the relationship between cumulative socioeconomic risk and suicide risk. Participants were 171 outpatients in a United States (U.S.) bipolar clinic (mean age = 39.0, 69.6% female, 73.7% Black/African American). Cumulative socioeconomic risk, perceived burdensomeness, and thwarted belongingness were positively associated with suicide risk. Perceived burdensomeness mediated the relationship between cumulative socioeconomic risk and suicide risk, but thwarted belongingness did not. Findings broadly suggest the IPTS and the SDOH framework can be fruitfully integrated to guide research and prevent suicide. The pathway from cumulative socioeconomic risk to suicide risk via perceived burdensomeness warrants further attention, particularly for individuals diagnosed with bipolar disorder. Implications for future studies of the IPTS, SDOH, and suicidality are discussed.

Food insecurity is a significant public health concern, particularly for African Americans in rural regions characterized by poverty and limited healthcare access. This study explores factors exacerbating the severity of food insecurity using the Social Determinants of Health (SDOH) framework among African Americans residing in rural Alabama. Compared to food security, low food security was associated with old age and interpersonal violence. Very low food security was associated with financial and transportation barriers to healthcare access, social isolation, and interpersonal violence. Findings highlight socioeconomic and environmental levers for targeted food-insecurity prevention among rural African Americans.

Spatial analysis is a population health methodology that can determine geographic distributions of asthma outcomes and examine their relationship to place-based social determinants of health (SDOH). To systematically review US-based studies analyzing associations between SDOH and asthma health care utilization by geographic entities. Pubmed, Medline, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature. Empirical, observational US-based studies were included if (1) outcomes included asthma-related emergency department visits or revisits, and hospitalizations or rehospitalizations; (2) exposures were ≥1 SDOH described by the Healthy People (HP) SDOH framework; (3) analysis occurred at the population-level using a geographic entity (eg, census-tract); (4) results were reported separately for children ≤18 years. Two reviewers collected data on study information, demographics, geographic entities, SDOH exposures, and asthma outcomes. We used the HP SDOH framework's 5 domains to organize and synthesize study findings. The initial search identified 815 studies; 40 met inclusion criteria. Zip-code tabulation areas (n = 16) and census-tracts (n = 9) were frequently used geographic entities. Ten SDOH were evaluated across all HP domains. Most studies (n = 37) found significant associations between ≥1 SDOH and asthma health care utilization. Poverty and environmental conditions were the most often studied SDOH. Eight SDOH-poverty, higher education enrollment, health care access, primary care access, discrimination, environmental conditions, housing quality, and crime - had consistent significant associations with asthma health care utilization. Population-level SDOH are associated with asthma health care utilization when evaluated by geographic entities. Future work using similar methodology may improve this research's quality and utility.

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

The Social Determinants of Health (SDH) framework is popular with academics and policy makers as a multifactorial explanation for unequal health attainment; Political Economy of Health is less debated and seldom a theoretical focus. We hypothesise that combining these theories unearths the roots of health inequalities and inequities. We propose a framework integrating both, which aims to not only identify ‘health gaps’ (SDH) but also aims to actively reduce these towards ‘political economy’-informed health policies. We conducted a literature search of four databases: PubMed, Embase, Web of Science and Scopus, to identify works which attempt to combine the social determinants of health and the political economy of health frameworks, explaining and interpreting health inequalities in different settings. Out of 156 results, we included 13 papers for analysis. The main themes that emerged from this body of literature were: private-public sector health inequalities, adverse local health outcomes and governmental policies fostering the improvement of local health outcomes. The concomitant application of political economy theories and the social determinants of health can be complementary to not only identify the so-called ‘health gaps’ between different social groups, but also to interpret these as outcomes of the economic system, affecting individuals and their social classes in different ways. Political Economy of Health can complement the SDH framework by inserting power relations into the interpretative mix as one of the keys to the creation, maintenance and reduction of health inequalities through health policy making.

Economic crises often expose the most vulnerable to higher health risks and tend to exacerbate existing inequalities. The Social Determinants of Health (SDoH) framework illustrates many layers of inequalities that would affect outcomes of the COVID-19 pandemic. The impacts of emergency policy responses considering the SDoH framework are important for all sectors in policymaking. However, its assessment in Global South countries is limited, due to high informality rates and data availability. We address this gap using a unique dataset that allows for the analysis of occupational categories before and after the COVID-19 pandemic in Brazil, incorporating the emergency assistance provided in 2020. Results show that, although labor earnings fell 4% for the self-employed at each death from COVID-19, increasing unemployment and inactivity among the typically most vulnerable, those effects were offset by emergency policies, reducing poverty. Groups often considered less vulnerable, such as formal employees, had an increase. The policy responses to this shock served then as a leveler of previous SDoH, despite ignoring the health-risk gradient there is along the income distribution. A poverty rebound that ensued after the sudden discontinuation of those policies is a lesson for future crises, and on how SDoH inequalities should be addressed.

The present study utilised the social determinants of health (SDH) framework to see whether indicators of the framework have an impact on anxiety and depression of people living in rural Black Belt communities in Alabama. Data from a convenient sample of 159 African-Americans aged 18 or older were from two sites in rural Alabama. The levels of anxiety and depression were measured by the Patient Health Questionnaire-9 (PHQ9). Multiple linear regression model was used to examine the association between SDH and anxiety and depression level of participants. The mean PHQ9 score of participants was 5.57 out of twenty-seven. Four SDH were significantly related to PHQ9 levels amongst participants: participants with higher food insecurity scores, higher transportation needs and higher threats to interpersonal safety tended to have higher scores in PHQ9. Moreover, health literacy levels were negatively associated with PHQ9 scores amongst participants. Our study highlights understanding SDH specifically for residents in rural communities that are socially and culturally isolated is important for developing preventive approaches that enhance access to mental health treatments. A comprehensive public health policy that incorporates our study findings is needed for the rural areas of the USA.

The social determinants of health (SDOH) framework identifies barriers to health care, education, financial stability, and other conditions that exist across socially determined parameters, often to the detriment of Communities of Color. Postsecondary healthcare students must be aware of these disparities. In order to address upstream and downstream healthcare equity, the SDOH framework must be leveraged as a cross-disciplinary curricular innovation to support interprofessional education. Historically Black Colleges and Universities have unrealized potential to develop extraordinary healthcare leaders; partnerships integrating SDOH can be a powerful force to advance health equity in the United States.

During the past 15-20 years the Social Determinants of Health (SDoH) framework has become the main approach to understand health inequalities. With this model a range of factors important for health and inequalities in health over the life-course have been connected into a larger framework. Despite its usefulness and popularity within the field, and wide use in influential reviews, the SDoH framework has not been easy to communicate to stakeholders in other sectors, and we cannot as yet see much of substantial societal change as a result of it. In this Commentary I try to discuss possible reasons behind our difficulties to communicate the SDoH perspective. Some of these reasons relate to how we frame and present the different parts of the framework, others are more linked to common beliefs and practices that I think we should rethink. In both cases, I believe that we would benefit from a more general discussion around these fundamental issues, both in order to communicate our important insights but also to better understand our own key study objective, namely how health inequalities are generated, sustained and potentially reduced.

Given the persistence of health inequities in the United States, scholars and health professionals alike have turned to the social determinants of health (SDH) framework to understand the overlapping factors that produce and shape these inequities. However, there is scant empirical literature on how frontline health and social service workers perceive and apply the SDH framework, or related movements such as the right to health, in their daily practice. Our study seeks to bridge this gap by applying constructs from the sociological imagination and structural competency (an emerging paradigm in health professions’ education) to understand the perspectives and experiences of social work case managers, community health workers, legal advocates, and mental health counselors at a maternal and child health center in a large US city. This frontline workforce displayed strong sociological imagination, elements of structural competency, and engagement with the principles of the right to health. Workers shared reflections on the SDH framework in ways that signaled promising opportunities for frontline workers to link with the global movement for the right to health. We offer a novel approach to understanding the relationships between frontline worker perspectives on and experiences with the SDH, sociological imagination, structural competency, and the right to health.

The social determinants of health (SDOH) framework has proven useful for research and practice in addressing the social causes of many health outcomes. However, its limitations may restrict its value as the world undergoes rapid ecological and social change. We argue that SDOH does not adequately incorporate rapidly changing or "far upstream" social processes (particularly social movements), the dialectics of social conflict and creative social innovation, or bidirectional causation. Ecosocial theory addresses some of these issues, yet dialectical frameworks offer additional insights during periods of rapid social change and disruption. The implications for research methods and practice are discussed. (Am J Public Health. 2025;115(11):1868-1876. https://doi.org/10.2105/AJPH.2025.308239).

<h3>Statement of Purpose</h3> Comprehensive fatal overdose prevention requires an understanding of the fundamental causes and broader context surrounding overdose. Using a Social Determinants of Health (SDOH) framework, we sought to examine unintentional and self-inflicted (i.e., suicide) overdose deaths in North Carolina (NC), focusing on individual characteristics, specific drug involvement, and contextual factors. <h3>Methods/Approach</h3> We used 2015–2019 NC death certificate data to identify unintentional and self-inflicted overdose deaths. Specific drug involvement was assessed by searching three literal text death certificate fields for drug mentions. County-level contextual factors encompassed five SDOH domains (economic stability, social/community context, health care access/quality, education access/quality, neighborhood/built environment) and were obtained from NC Institute of Medicine and County Health Rankings. We calculated descriptive statistics by intent for specific drug involvement and a variety of rich contextual factors. <h3>Results</h3> During 2015–2019, 9% of NC drug overdose deaths were self-inflicted and 89% were unintentional. The majority of suicide overdoses occurred among females (62%) and adults ≥45 years (69%), whereas unintentional overdoses were more common among males (66%) and persons &lt;45 years (62%). Unintentional overdoses largely involved illicit drugs [fentanyl (47%), cocaine (33%), heroin (29%)]. Suicide overdoses frequently involved prescription opioids [oxycodone (18%), hydrocodone (10%)] and antidepressants (41%). Overall, overdose deaths tended to occur in under-resourced counties across all domains of SDOH. Compared to suicide overdoses, unintentional overdoses occurred more often among residents of under-resourced counties with differences most pronounced for economic stability-related factors. <h3>Conclusions</h3> We identified notable distinctions between unintentional and suicide overdose deaths in demographics and drug involvement. While we observed contextual differences by intent, the assessment of SDOH demonstrated that overdose mortality is broadly associated with marginalization across all domains, which highlights the value of allocating resources to prevention and intervention approaches that target upstream causes of overdose (e.g., housing first, violence prevention programs).

Objectives Depression among Korean American (KA) immigrants in rural Alabama is understudied. This study aims to utilize the social determinants of health (SDOH) framework to explore factors associated with depressive symptoms among KA immigrants living in rural communities of Alabama. Design Data were collected from two sites in rural Alabama from September 2019 to February 2020. Convenience sampling was conducted to recruit study participants from the KA community. A total number of 261 KA immigrants aged 23–75 were included in the study. All measures originally in English were translated into Korean using back-translation to assure comparability and equivalence in the meaning of measures. Multiple linear regression modeling was used to explore the predictors of depression. Results Perceived race discrimination was significantly associated with greater depressive symptoms (β = .180, SE = .534, p < .01). Three SDOH were identified to have significant relationship with depressive symptoms. Participants who could not see a doctor because of cost (β = .247, SE = 1.118, p < .001), had lower level of health literacy (β = -.121, SE = .280, p < .05), and had higher social isolation scores (β = .157, SE = .226, p < .05) tended to have higher scores of depressive symptoms. Conclusion Rural-living KA immigrants’ depression can be significantly affected by race discrimination and SDOH factors, emphasizing the need for culturally competent interventions and services. Policymakers, federal and local governments, non-governmental organizations, and social workers can make joint efforts to address racial discrimination and improve the mental health services among immigrant populations, especially those living in rural areas.

Aim Depression is one of the major mental health crises impacting refugees who have endured traumatic experiences before and after resettlement in a new country. Guided by the Social Determinants of Health (SDH) framework, this study examined factors associated with depressive symptoms among refugees resettled in the United States (U.S). Subjects and methods This study employed a cross-sectional survey derived from the 2020 Annual Survey of Refugees (ASR). The participants were refugees resettled in the U.S. between 2014 and 2019 (N = 1527). Ordinal logistic regression was conducted to determine the significant associations between selected SDH domains and self-reported depressive symptoms among refugees resettled in the U.S. Results Across five selected domains of SDH, refugees who reported overall good physical health (β = -0.96, AOR = 0.38, 95% CI = 0.27–0.53, p &lt; .001), had access to Medicaid and other types of health insurance (β = -0.43, AOR = 0.65, 95% CI = 0.46–0.93, p &lt; .05), and felt welcomed in their resettled communities (β = -0.57, AOR = 0.57, 95% CI = 0.45–0.72, p &lt; .001), were associated with a lower likelihood of exhibiting depressive symptoms during the past 30 days. However, refugees who experienced discrimination were associated with higher odds of exhibiting depressive symptoms during the past 30 days (β = 0.58, AOR = 1.79, 95% CI = 1.23–2.60, p &lt; .001). Conclusion This study underscores the need for policymakers and service providers to advocate for improved access to affordable health insurance and mental health services, foster a sense of community connectedness, and address discrimination to alleviate depressive symptoms impacting vulnerable refugees resettled in the U.S.