What are SDOH?

Social determinants of health (SDOH) are the non-medical variables and forces that impact everyone’s health. These factors change throughout our lives and affect our well-being. To better understand the big picture of health, Healthy People 2030 groups social determinants into five categories.

Social Determinants of Health

SDOH Categories

1. Economic Stability	Access to food, housing, health care, and education Employment opportunities
2. Education Access and Quality	Ability to participate in school Access to trade schools, training programs, and colleges
3. Health Care Access and Quality	Access to insurance as well as primary and preventative care Proximity to qualified providers, pharmacies, and medical supplies
4. Neighborhood and Built Environment	Access to healthy food and opportunities to exercise Air quality and water safety Exposure to or absence of hazards such as noise and secondhand smoke Physical safety or rates of violence and exposure to crime
5. Social and Community Context	Civic participation, inclusion, and discrimination Freedoms and rates of incarceration Positive, negative, or neutral workplace conditions Social relationships—supportive and unsupportive

Everyone has different relationships to their social determinants of health. How SDOH affect our lives can help, hinder, or neutrally affect health experiences and outcomes.

Why Do SDOH Matter in Communication Sciences and Disorders (CSD)?

SDOH are highly relevant to audiology and speech-language pathology practice. By considering where your clients live, work, play, and age, you can better understand the protective factors and social risks in their lives that impact treatment. These insights may help you customize care plans and communicate client needs. Care teams, employers, payers, clinicians, and clients can all benefit from learning about SDOH. Understanding SDOH also helps the CSD professions contribute to better treatment outcomes and quality of life for people with communication disorders.

Studies show that people with communication disorders have poorer health and health care outcomes than people without communication disorders (Morris, 2022; Stransky et al., 2018). Health Care Access and Quality and other SDOH often play a part in clients’ health disparities.

SDOH information opens opportunities for clinicians and employers to address and mitigate CSD outcome gaps. It’s important to ask:

How can you improve policies and services to facilitate care?
How can you use SDOH knowledge to better help each client?
How can you partner with other professionals and community organizations to improve health outcomes?

Within your scope as a clinician, you can influence movement toward health equity by removing barriers to care and advocating for policies that accommodate for client SDOH.

Audiologists, SLPs, and assistants strive to provide person-centered, culturally responsive care that considers each whole individual. You enhance your clinical perspective by taking your clients’ SDOH into account.

Protective Factors, Social Risk Factors, Social Needs

Definitions

SDOH refer to variables shaped by policies, infrastructure, and culture. People may share SDOH. They may live in the same Neighborhood and Built Environment, for example. Their shared SDOH could mean that they share protective factors or social risk factors. However, their factors and needs may also differ on a person-to-person basis. Protective factors, social risk factors, and social needs refer to how SDOH relate to clients on an individual level.

Protective factors are circumstances that can benefit a person’s well-being and health outcomes. Abundant nutritious food, access to clean air, and supportive friend groups are protective factors.

Social risk factors are circumstances associated with poor health outcomes. Housing insecurity, unreliable transportation, and social isolation are social risk factors.

Social needs arise due to gaps in access to goods and services. For example, if an infant requires a specialized feeding formula that isn’t sold in any of the stores near where their family lives, they experience a social need for nutritional support.

Case Example: Identifying SDOH, Factors, and Needs

A second-grader’s individualized education program (IEP) team notices that the child has difficulty concentrating in the classroom and during speech-language sessions. The student rarely has money for lunch and doesn’t consistently bring snacks to school. She asks friends for food during snack time and says that she’s hungry. The student’s parents attend conferences and talk with their child’s IEP professionals. They mention that the grocery stores in their neighborhood are “too pricey.” The teacher and the SLP suspect that the child’s family may be experiencing food insecurity. The school social worker enrolls the student in the school’s free lunch and breakfast program. As a result, the student focuses better, participates more, and improves academically. Her parents reflect that “it makes it easier” now that their child receives two meals at school . The child’s team gives a list of local food support resources to the family.

Which SDOH are involved?	Economic Stability: Affordability of food for the family Education Access and Quality: Child attends school Health Care Access and Quality: Child has an IEP team Neighborhood and Built Environment: Access to affordable food Social and Community Context: Parents are able to attend and participate in conferences
What's the protective factor?	Supportive network: The parents and school support team are able to communicate in support of the child’s well-being.
What's the social risk factor?	Food insecurity: The child has limited or uncertain access to food.
What's the social need?	Food support: The child experiences hunger and needs food support.

Remember: Social risk factors don’t always result in social needs. A child may be at social risk for food insecurity because of fluctuations in their family’s economic stability. However, if the child has access to nutritious food regardless, then they don’t experience the social need for food support.

It's important to be aware of a client’s social risk factors because their circumstances may change and escalate to social needs. For example, a family that declines food assistance during the school year may find a resource list helpful during summer break. As appropriate, you can prepare to offer referrals and resources for social needs.

SDOH and Health Equity

Social determinants of health help contextualize the relationships between the health inequities, health disparities, and health care disparities your clients face. Inequities expressed through SDOH affect clients in every practice setting. It’s not within your individual clinical capacity to solve every social need or systemic problem. However, you can participate in collaboration across organizations and social systems and contribute toward greater health equity. Learn more about inequities in CSD in this ASHA Voices podcast, and explore examples of how interprofessional teams advocate to close gaps in care with Health Equity Case Studies. For more background, read an open-access Journal of Speech, Language, and Hearing Research article about Striving Toward Equity in Health Care for People With Communication Disabilities.