Social Determinants of Health, Structural Racism, and the Impact on Child and Adolescent Mental Health.

Abstract

In recent years, there has been a greater emphasis on examining the factors, particularly the social factors, that affect health outcomes and contribute to population health inequities. The social determinants of health, as defined by the World Health Organization, are "the conditions in which people are born, grow, work, live, and develop, and the wider set of forces, including economic policies, social norms, and political systems, that shape the conditions of daily life and impact health outcomes."¹ The social determinants of mental health (SDoMH) are similar, but include the added societal stigma associated with mental health and substance use disorders. The SDoMH often receive less focus and study, particularly in youth. Table1 lists several examples of social determinants of mental health for children and adolescents and examples of how to address them in the clinical setting.¹ The SDoMH are particularly relevant for children, as they are reliant on the adults who care for them and have even less control over these societal factors. Additionally, the physical, cognitive, emotional, and social development that occurs during this critical time lays the foundation for mental health and well-being into adulthood. It is important that mental health providers recognize these SDoMH, as they invariably impact the clinical presentation of the children they treat. However, to truly address the SDoMH and improve outcomes for all children, clinicians must understand the major driving force behind them-structural racism.