The social determinants of suicide: an umbrella review.

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

Purpose: The type 2 diabetes (T2D) burden is disproportionately concentrated in low- and middle-income economies, particularly among rural populations. The purpose of the systematic review was to evaluate the inclusion of rurality and social determinants of health (SDOH) in documents for T2D primary prevention. Methods: This systematic review is reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We searched 19 databases, from 2017-2023, for documents on rurality and T2D primary prevention. Furthermore, we searched online for documents from the 216 World Bank economies, categorized by high, upper-middle, lower-middle, and low income status. We extracted data on rurality and the ten World Health Organization SDOH. Two authors independently screened documents and extracted data. Findings: Based on 3318 documents (19 databases and online search), we selected 15 documents for data extraction. The 15 documents applied to 32 economies; 12 of 15 documents were from nongovernment sources, none was from low-income economies, and 10 of 15 documents did not define or describe rurality. Among the SDOH, income and social protection (SDOH 1) and social inclusion and nondiscrimination (SDOH 8) were mentioned in documents for 25 of 29 high-income economies, while food insecurity (SDOH 5) and housing, basic amenities, and the environment (SDOH 6) were mentioned in documents for 1 of 2 lower-middle-income economies. For U.S. documents, none of the authors was from institutions in noncore (most rural) counties. Conclusions: Overall, documents on T2D primary prevention had sparse inclusion of rurality and SDOH, with additional disparity based on economic status. Inclusion of rurality and/or SDOH may improve T2D primary prevention in rural populations.

The importance for tuberculosis of mitigating economic crises

Previous studies comparing the social and behavioural determinants of health in Europe have largely focused on individual countries or combined data from various national surveys. In this article, we present the findings from the new rotating module on social determinants of health in the European Social Survey (ESS) (2014) to obtain the first comprehensive comparison of estimates on the prevalence of the following social and behavioural determinants of health: working conditions, access to healthcare, housing quality, unpaid care, childhood conditions and health behaviours. We used the 7th round of the ESS. We present separate results for men and women. All estimates were age-standardized in each separate country using a consistent metric. We show country-specific results as well as pooled estimates for the combined cross-national sample. We found that social and behavioural factors that have a clear impact on physical and mental health, such as lack of healthcare access, risk behaviour and poor working conditions, are reported by substantial numbers of people in most European countries. Furthermore, our results highlight considerable cross-national variation in social and behavioural determinants of health across European countries. Substantial numbers of Europeans are exposed to social and behavioural determinants of health problems. Moreover, the extent to which people experience these social and behavioural factors varies cross-nationally. Future research should examine in more detail how these factors are associated with physical and mental health outcomes, and how these associations vary across countries.

Achieving the Quadruple Aim: Treating Patients as People by Screening for and Addressing the Social Determinants of Health

Ten years have passed since the release of the final report of the World Health Organization (WHO) Commission on Social Determinants of Health (CSDH),1 a landmark document that provided a global blue‐print for the health promotion community and the stakeholders we work with. Three overarching recommendations were outlined, improving daily living conditions; tackling the inequitable distribution of power, money and resources; and measuring and understanding the problem and assessing the impact of action.1 The extent to which progress has been, and continues to be, made is contested. This editorial briefly reflects on what has been achieved over the past decade—in broad terms—about action on the social determinants of health (SDH) in Australia. We deliberately take a balanced view by highlighting the weaknesses and strengths in what has been achieved by governments, non‐government organisations, research institutions, peak bodies and civil society. We also reflect on the ongoing role that the Australian Health Promotion Association (AHPA) has played in advancing our understanding about, and action on, the SDH.

Social determinants of health (SDH) are important determinants of long-term conditions and multimorbidity in the general population. The intersecting relationship between SDH and multimorbidity in people with HIV remains poorly studied. A cross-sectional study investigating the relationships between eight socio-economic parameters and prevalent comorbidities of clinical significance and multimorbidity in adults of African ancestry with HIV aged 18-65 years in South London, UK. Multivariable logistic regression analysis was used to evaluate associations between SDH and comorbidities and multimorbidity. Between September 2020 and January 2022, 398 participants (median age 52 years, 55% women) were enrolled; 85% reported at least one SDH and 72% had at least one comorbidity. There were no associations between SDH and diabetes mellitus or kidney disease, few associations between SDH (job and food insecurity) and cardiovascular or lung disease, and multiple associations between SDH (financial, food, housing and job insecurity, low educational level, social isolation, and discrimination) and poor mental health or chronic pain. Associations between SDH and multimorbidity mirrored those for constituent comorbidities. We demonstrate strong associations between SDH and poor mental health, chronic pain and multimorbidity in people of black ethnicities living with HIV in the UK. These findings highlight the likely impact of enduring socioeconomic hardship in these communities and underlines the importance of holistic health and social care for people with HIV to address these adverse psychosocial conditions.

Preventing suicide is one of the top priorities in public health policy. Identifying key social determinants of health (SDOH) in suicide risk is critical for informing clinical practices, future research, and policy solutions to prevent suicide. To examine the associations of SDOH with suicide-related outcomes. Studies published before July 2023 were searched through PubMed, PsycINFO, Embase, and Web of Science. The date of the search was August 4, 2023. We included the most up-to-date meta-analyses reporting associations between SDOH and suicide-related outcomes. Three independent reviewers extracted data and conducted quality assessment using the Joanna Briggs Institute Checklist for Systematic Reviews and Research Syntheses. The main outcomes of interest were suicide mortality, suicide attempt, and suicidal ideation. A total of 46 meta-analyses met inclusion criteria. For suicide mortality, justice system-involved individuals in the community, exposure to others' and parental suicide, firearm accessibility, divorce, experience in foster care, release from incarceration, and midlife (age 35-65 years) unemployment were the SDOH with consistently strong effects. Individuals released from incarceration demonstrated a high prevalence of suicide mortality (114.5 per 100 000 persons). With regard to suicide attempt, experience of childhood abuse and maltreatment and sexual assault, gender and sexual minority status, and parental suicide mortality were the strongest risk factors. The prevalence of suicide attempt among homeless individuals (28.9%; 95% CI, 21.7%-37.2%) and incarcerated female youths (27%; 95% CI, 20%-34%) and adults (12.2%; 95% CI, 7.1%-17.2%) was high. For suicidal ideation, identification as bisexual and intimate partner violence in women were the strongest risk factors. The prevalence of lifetime suicidal ideation in homeless individuals was 41.6% (95% CI, 28.6%-56.0%). Protective factors associated with reduced risk of suicide mortality were religious affiliation and being married. School connectedness showed protective associations against suicide attempt and suicidal ideation. Tailoring interventions and future research for identified priority subpopulations, such as justice system-involved individuals in the community, and implementing policy measures addressing the SDOH that showed strong associations with suicide mortality, attempts, and ideation, such as gun licensing requirements, are critical to counteracting social and environmental forces that increase suicide risk.

The fields of psychiatry and mental health are increasingly recognizing the importance of social determinants of health (SDOH) and their impact on mental health outcomes. In this overview, the authors discuss the recent research, from the past 5 years, on advances made in SDOH work. SDOH frameworks and theories have expanded to include more social conditions, from traumas associated with immigration to psychosocial and community strengths, that impact mental health and well-being. Research has consistently shown the pervasive deleterious impacts of inequitable social conditions (e.g., food insecurity, housing instability) on minoritized populations' physical and mental health. Social systems of oppression (e.g., racism, minoritization) have also been shown to confer higher risk for psychiatric and mental disorders. The COVID-19 pandemic illuminated the inequitable impact of the social determinants of health outcomes. More efforts have been made in recent years to intervene on the social determinants through interventions at the individual, community, and policy levels, which have shown promise in improving mental health outcomes in marginalized populations. However, major gaps remain. Attention should be paid to developing guiding frameworks that incorporate equity and antiracism when designing SDOH interventions and improving methodological approaches for evaluating these interventions. In addition, structural-level and policy-level SDOH efforts are critical for making long-lasting and impactful advances toward mental health equity.

A Public Health, Whole-of-Government Approach to National Suicide Prevention Strategies

In human beings, the development of a child involves biological, emotional, and psychological changes that happen between birth and the conclusion of adolescence. Childhood is divided into three stages: early childhood, middle childhood, and late childhood (preadolescence). Early childhood is typically from infancy to six years of age. The methods for maintaining health and dealing with already-existing sicknesses and the social and economic settings in which children are born, grow up, live, and eventually work are referred to as the social determinants of health. Despite advances in health, child malnutrition remains a problem salutariness (severe) issue with massive human and economic resource implications. There is currently a growing corpus of research on how early development influences a child’s success later in life. From conception to two years of age, the first 1,000 days of life are becoming more well-recognized as important for the development of brain circuits that lead to linguistic, cognitive, and socio-emotional abilities, all of which are predictors of later-life labor market outcomes. The social patterning of health, sickness, and illness can be influenced by the social determinants of a child's health. This can also influence a person's overall well-being and functioning throughout their lifetime factors of a child's health, early childhood care, and development from an ecological standpoint, and as planned, a participatory approach in early childhood care and development is implemented. The social determinants of health are the elements that cause positive or negative changes in health or alter disease risks. The social determinants of health, which are different from medical treatment, can be altered by social policy. Social gradients and health equality are ideas that are related to understanding how social factors impact health.

The persisting life-expectancy 'gap' between First Nations and non-First Nations Australians is fundamentally driven by the social determinants of health. These include income and social protection, access to adequate housing and food security, among others. These factors are particularly prominent in Central Australia. Inadequate housing has led to some of the highest rates of Streptococcus pyogenes infection in the world, which in turn drives an extremely high prevalence of rheumatic heart disease. Food insecurity and inadequate social protection manifesting as energy insecurity result in inadequate nutrition and have resulted in a huge burden of diabetes in Central Australia. These factors, combined with social exclusion, racism and the pervasive effect of colonisation, also drive a high rate of alcohol misuse. Only by prioritising equity in these 'social determinants' and emphasising the importance of First Nations leadership in formulating and implementing solutions will health inequity be addressed.

Global action on social determinants of health

Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.

This supplement to Public Health Reports (PHR) focuses on data systems and their use in addressing social determinants of health (SDH). This particular topic requires attention now given the evidence of increasing burden and worsening inequities in some health outcomes, in spite of decades of work to change individual behaviors, as well as the need to be efficient in our use of existing data. A holistic approach to disease prevention is urgently needed to reduce the inequities that have been perpetuated in our society for so long. Despite concerted, targeted, and coordinated efforts to reduce inequities in health outcomes, gross inequities still exist,1–4 and some evidence indicates that the gap between the best health outcomes and the worst health outcomes is growing.1,3–5 Well-meaning efforts have substantially focused on individual-related behavior changes, with less focus on wider social and structural determinants of health, which can be defined as follows:6,7 Structural factors include those physical, social, cultural, organizational, community, economic, legal, or policy aspects of the environment that impede or facilitate efforts to avoid disease transmission. Social factors include the economic and social conditions that influence the health of people and communities as a whole, and include the conditions for early childhood development, education, employment, income and job security, food security, health services, and access to services, housing, social exclusion, and stigma.8 In addition to addressing individual factors, there is an urgent need to address social and structural factors and to better understand their relationship to each other as we develop effective programs and policies to reduce inequities. A holistic approach to disease prevention involves not only addressing individual, social, structural, and environmental determinants, but also working with a wide array of sectors, such as health, education, justice, environment, and labor. Additionally, it means working with diverse kinds of data, including disease surveillance, legal, land use, marketing, workforce, education, and financial. Making the best use of a wide variety of data at the individual, neighborhood, community, and county levels, for example, can provide a more complete description of the underlying factors that may influence health outcomes than using disease surveillance data alone. As a matter of fact, using disease surveillance data alone, which often are limited to variables such as disease of interest, age, sex or gender, and race/ethnicity, can be stigmatizing and only tells part of the story. Public health professionals have an obligation to fairly and accurately describe disease occurrence in populations. As a result, we should be compelled to use data from available sources to provide a complete picture of the environment in which the disease occurs and any underlying factors contributing to its occurrence. Addressing underlying factors of health has been advocated by many health practitioners for decades.1,9–12 The Institute of Medicine Committee on Public Health Strategies to Improve Health released a report in 2010 that recommended gathering, analyzing, and communicating health information that includes not only disease-outcome data, but also data on underlying factors contributing to poor health.13 In many cases, national disease surveillance systems do not include information on underlying determinants of disease, necessitating linking to existing sources of social, structural, legal, environmental, and financial data to provide a more comprehensive description of the affected population.14 This special issue of PHRaims to reflect on the types of data we routinely gather, analyze, report, and communicate, and it calls us to take a holistic approach to data use both in the sources (e.g., United Nations, Centers for Disease Control and Prevention [CDC], Census Bureau, Department of Transportation, and Department of Justice) and kinds (e.g., disease outcome, policy, financial, land use, service usage, achievement, and segregation) of data used in public health. It calls us to be good public health stewards by challenging us to move beyond our routine analyses based mostly on individual-level data and include data from other sectors and levels in the work we do. This supplement provides examples of innovative uses and analyses of data for local, state, and national governments and organizations to consider. Promoting health equity through a holistic approach is a major strategic priority of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB -Prevention (NCHHSTP).15 NCHHSTP's recent white paper entitled “Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States” calls for a systematic approach to monitoring disease by simultaneously reporting on disease outcomes and underlying factors of poor health.16 NCHHSTP is also placing more emphasis on addressing structural determinants of health, including health policy, economic and social interventions, and cross-sectoral collaborations. The articles in this supplement clearly expand the knowledge base on social determinants and data use and are examples of the holistic approach to public health suggested in the CDC white paper.