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SDOH in Communities

SDOH, although experienced by individuals, exist at the community level. Healthcare systems that learn about the communities their patients live in, and the community-level barriers members can face to becoming and staying healthy, can better adapt their recommendations to people’s lives. SDOH can be categorized into five key areas:

• Social context: (e.g., demographics, social networks and supports; social cohesion; racial, ethnic, religious, and gender discrimination; community safety; criminal justice climate; civil participation).
• Economic context (e.g., employment, income, poverty).
• Education (e.g., quality of day care, schools, and adult education; literacy and high school graduation rates; English proficiency).
• Physical infrastructure (e.g., housing, transportation, workplace safety, food availability, parks and other recreational facilities, environmental conditions, sufficiency of social services).
• Healthcare context (e.g., access to high-quality, culturally and linguistically appropriate, and health literate care; access to insurance; healthcare laws; health promotion initiatives; supply side of services; attitudes towards healthcare; and use of services).

Social Needs

While everyone who lives in a community shares exposure to the same SDOH, individuals have varying social needs. For example, one member of the community might be homeless, while another has adequate housing. Increasingly, healthcare systems are trying to assess the specific social needs of their patients and help meet those needs. These can include:

• Social support (e.g., social isolation).
• Communication barriers (e.g., hearing or vision impairment, lack of English proficiency).
• Trauma (e.g., adverse childhood experiences, domestic violence, elder abuse).
• Educational barriers (e.g., learning difficulties, limited literacy).
• Food insecurity (e.g., going hungry, worrying that you won’t have enough food).
• Housing insecurity (e.g., homelessness; living in overcrowded, unsafe, or unstable conditions).
• Financial strain (e.g., being unable to pay for medicine and other essentials).
• Employment insecurity (e.g., being un- or under-employed).
• Lack of access to legal services (e.g., combat discrimination, unsafe workplace or housing, criminal defense, immigration status, victim or protection services, guardianship or custody).
• Lack of transportation (e.g., inability to get to workplace or healthcare sites).
• Physical environment (e.g., lead paint).

To learn about AHRQ tools for assessing SDOH and addressing social needs, visit SDOH Practice Improvement.