Social determinants of health: how much does each matter?
The Social determinants of health (SDOH) are the non-medical, environmental, and economic conditions in which people are born, grow, live, work, and age. Research shows that these factors have a greater influence on health outcomes and life expectancy than genetics or access to clinical healthcare alone.
The above image shows the five social determinants of health domains as set out by Healthy People 2030, and weighted using the County Health Rankings model.
Healthy People 2030 does not state how much each determinant matters. To give a sense of relative influence, this chart borrows the factor weights from the County Health Rankings model (University of Wisconsin Population Health Institute; Booske et al., 2010) and regroups them into the Healthy People 2030 domains.
On that basis the five SDOH domains account for 70% of what shapes health outcomes. The remaining 30% is health behaviours, which Healthy People 2030 places outside its SDOH framework but which is shown here in grey so the chart totals 100%.
The weights are informed estimates rather than precise measurements, and the mapping is illustrative, not an official crosswalk: community safety, for example, could equally sit under social and community context.
The domains:
■ Economic stability · 20%
Income 10% + employment 10%. Money and work underpin housing, diet and stress.
■ Health care access and quality · 20%
Access to care 10% + quality of care 10%. Matters, but is a smaller share than most people assume.
■ Neighbourhood and built environment · 15%
Air and water 5% + housing and transit 5% + community safety 5%.
■ Education access and quality · 10%
Education 10%. Larger indirect effect through income and health literacy.
■ Social and community context · 5%
Family and social support 5%. Small direct weight, though isolation strongly shapes behaviour.
■ Health behaviours · 30%
Tobacco 10%, diet and exercise 10%, alcohol and drugs 5%, sexual activity 5%. Not an SDOH domain, but needed to make 100%.