Social Determinants of Health 

Medical care is a relatively small contributor to health outcomes. Social, behavioral, and physical environment factors account for 80 percent of a population’s health outcomes. Nonprofit human service agencies are critical partners in efforts to bend the nation’s health care cost curve because they address vulnerable populations’ social and behavioral factors through the provision of a wide range of services, including access to safe, stable housing; nutritious food; counseling services; recreation programs; transportation; and advocacy. 

Health Care Spending

The U.S. health care crisis, which is fueled by rising costs and a high demand for medical services, affects all government and private expenditures and services. In addition, the need for often costly medical treatment is not evenly distributed among all people. "In 2015, half of the population accounted for 97% of health spending [and] the 50% of the population with the lowest spending accounted for 3% of all total health spending."1 

Discussions of cost containment often target medical and insurance providers. They ignore that the primary drivers of the need for medical services are socially and behaviorally motivated. In fact, a recent study concluded that “states with higher ratios of social to health spending had better health outcomes one and two years later.”6

Examples of Social Determinants 

Health is shaped not only by biology, but by “where we live, labor, learn, play, and pray.”2, 3, 7  Examples of social determinants that affect health status include: Access to healthy food; Access to safe places for exercising; Access to, and the quality of, health services; Access to safe, stable housing; Environmental pollution; and Education level, including basic health literacy. The impact of multiple adverse childhood experiences has also been shown to be a strong factor in determining a person’s physical health throughout a person’s lifetime.4 Advances in neurophysiology have illuminated biological pathways between cumulative stress, brain development, and other diseases. Social and environmental determinants play a role in many  chronic conditions, such as diabetes, hypertension, asthma, and heart disease. 

Impact of Social Determinants 

Many factors determine an individual’s health: genetic, behavioral, medical, and social. There is very strong consensus that medical care itself is a relatively small part of the picture. As depicted in the visual below, fully half of health outcomes can be explained by socio-economic factors and physical environment factors, and another 30 percent by health behaviors.3 

America’s History of Improving Health by Improving Social Factors

Relatively recent increases in the effectiveness and cost of medical care can distract individuals from the history of America’s progress in health and life expectancy. During the first half of the 20th century, the leading causes of disease and death in the U.S., which include Typhoid, were associated with the unhealthy living  conditions.5 The second half of the 20th century saw an increased focus on clinical and nonclinical preventive  strategies, including childhood immunizations, smoking cessation, healthy eating, and exercise. Further attention in the 21st century to social determinants like access to healthy food, effective parenting, and safe neighborhoods, continues this movement toward heightened disease prevention and decreased disease treatment.

How Attention to Social Factors Improves Health

While the work of health providers is placing increased attention on social factors, the puzzle of effective health promotion cannot be solved by the medical sector alone. Community development approaches address issues like little or no access to healthy food or the absence of quality child care and employment opportunities. Nonprofit human service agencies promote healthier communities by providing home visitation, transportation, care coordination, recreation, education, elder care, and a host of other services. Supporting neighborhoods and social strategies that protect individuals’ opportunities to start out and remain healthy will likely depend on collaboration between multiple sectors.  

About the Alliance for Strong Families and Communities

The Alliance is a national strategic action network driven by members aligned through shared ownership and a common vision to achieve a healthy and equitable society. We aggregate the very best sector knowledge and serve as an incubator for learning and innovation to generate new solutions to the toughest problems. We accelerate change through dynamic leadership development and collective actions to ensure policies and systems provide equal access and opportunity for: Health and well-being, Economic opportunity, Educational success, and Safety and security. 


  1. Henry J. Kaiser Foundation. (2017). How do health expenditures vary across the population? Retrieved from 
  2. Koh, H. K. (2011). The ultimate measures of health. Public Health Reports, 126(Suppl 3), 14–15. Retrieved from
  3. Alliance for Strong Families and Communities, American Public Human Services Association, Oliver Wyman, SeaChange Capital Partners, & Marsh & McLennan Companies. (2018). A national imperative: Joining forces to strengthen human services in America. Retrieved from 
  4. Felitti, V. J., Anda, R. F., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14, 245-258.
  5. Booske, B.C., Athens, J. K., Kindig, D. A., Park, H., & Remington, P.(2010). Different perspectives for assigning weights to determinants of health. Retrieved from 
  6. Bradley, E., Canavan, M., Rogan, E., Talbert-Slagle, K., Ndumele, C., et al. Variation in health outcomes: The role of spending on social services, public health, and health care, 2000–09. (2016). Health Affairs, 35, 760-768.
  7. Aetna Foundation & U.S. News & World Report. (2018). Healthiest communities rankings. Retrieved from