Social Determinants of Health

Social determinants of health (SDOH) are the structural and societal conditions that influence health beyond individual biology or behavior. They span economic stability (income, employment), education, the neighborhood and built environment, social and community context, and access to health care. These upstream factors often explain more of the variation in population health than clinical care itself.

They matter in cancer prevention and population science because exposures like screening, healthy food, safe environments, and timely treatment are unevenly distributed along social lines. SDOH are the engine behind many health disparities, and addressing them is essential to reducing the population burden of disease — not just treating individuals one at a time.

A common analytic pitfall is treating SDOH purely as confounders to be adjusted away, which can obscure them as the very causes of interest, or conversely adjusting for a variable that lies on the causal pathway (a mediator) and thereby explaining away the effect you mean to measure. How you handle SDOH depends on whether they are the exposure, the confounder, or the mechanism in your causal question.

For example, lower cancer-screening rates in a community might trace to transportation access, work flexibility, and insurance coverage — social determinants that no amount of individual health education alone will fix.