Social Determinants of Health: A Concept Analysis
DOI:
https://doi.org/10.64397/nepj.v01i03.2026.a24Keywords:
social determinants of health, health equity, concept analysisAbstract
Introduction: Social determinants of health are social and economic factors, often beyond a person’s control, that directly impact the capacity of individuals and communities to achieve positive health outcomes. These determinants are central to the provision of healthcare that is equitable and non-biased.
Aim: This article aims to examine and provide context for the concept of social determinants of health and to demonstrate the interconnectedness and breadth of the concept for nursing education.
Methods: Walker and Avant’s eight-step approach to concept analysis was utilized. Literature was retrieved from PubMed and CINAHL databases using keywords: social determinants of health, health equity, health disparity, and racial bias. Websites and reference lists used were from the World Health Organization, Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, American Medical Association and the American Academy of Family Physicians.
Results: Social determinants of health as a concept, contributes to the delivery of healthcare, and supports public health policy, community engagement, advocacy for health equity, incorporation of social services, nursing and medical education, and epidemiology. Defining attributes include social factors, influence on health inequities, and potential impact at levels ranging from personal to societal. Factors such as slavery, segregation, economic recession, and cultural norms are antecedents.
Conclusion: This article clarifies social determinants of health as a concept and provides case examples that demonstrate how the components interconnect to create a complex web of barriers to health. This concept is central to nursing education and the implementation of interventions that improve health equity and outcomes.
References
1. Adler, N. E., Glymour, M. M., & Fielding, J. (2016). Addressing social determinants of health and health inequalities. JAMA, 316(16), 1641-1642. https://doi.org/10.1001/jama.2016.14058
2. American Academy of Family Physicians. (2018). Addressing social determinants of health in primary care: team based approach for advancing health equity. Retrieved October 10, 2023 from https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/team-based-approach.pdf
3. American Academy of Family Physicians Board of Directors. (2019). Advancing health equity by addressing the social determinants of health in family medicine: Position paper. American Academy of Family Physicians. Retrieved October, 1, 2023 from https://www.aafp.org/about/policies/all/social-determinants-health-family-medicine-position-paper.html
4. American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://www.aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
5. American College of Obstetricians and Gynecologists. (2025). Tailored prenatal care delivery for pregnant individuals. Retrieved April 9, 2026 from https://www.acog.org/clinical/clinical-guidance/clinical-consensus/articles/2025/04/tailored-prenatal-care-delivery-for-pregnant-individuals
6. American Medical Association. (2020). New AMA policies recognize race as a social, not biological, construct. Retrieved June 14, 2024 from https://www.ama-assn.org/press-center/press-releases/new-ama-policies-recognize-race-social-not-biological-construct
7. Amutah, C., Greenidge, k., Mante, A., Munyikwa, M., Surya, S. L., Higginbotham, E., Jones, D. S., Lavizzo-Mourey, R., Roberts, D., Tsai, J., & Aysola, J. (2021). Misrepresenting race - The role of medical schools in propagating physician bias. New England Journal of Medicine, 384(9), 872-878. https://doi.org/10.1056/NEJMms2025768
8. Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Cmaj, 188(17-18), E474-e483. https://doi.org/10.1503/cmaj.160177
9. Centers for Disease Control and Prevention. (2024a). Community health workers for COVID response and resilient communities. Retrieved August 24, 2024 from https://www.cdc.gov/covid-community-health-workers/php/about/index.html
10. Centers for Disease Control and Prevention. (2024b). Social determinants of health. Retrieved August 24, 2024 from https://www.cdc.gov/health-disparities-hiv-std-tb-hepatitis/about/social-determinants-of-health.html?CDC_AAref_Val=https://www.cdc.gov/nchhstp/socialdeterminants/faq.html
11. Centers for Disease Control and Prevention. (2024c). Social Determinants of Health (SDOH). Retrieved August 24, 2024 from https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html
12. Centers for Medicare & Medicaid Services. (n.d.). Health equity. Retrieved June 30, 2024 from https://www.cms.gov/priorities/innovation/key-concepts/health-equity#:~:text=Health%20equity%20is%20when%20everyone,for%20addressing%20any%20disparities%20identified
13. Cerio, J. (2025). Social determinants of health integration in an associate degree concept-based curriculum: A qualitative study. Nurse Education in Practice, 89, 104601. https://doi.org/https://doi.org/10.1016/j.nepr.2025.104601
14. Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The association between income and life expectancy in the United States, 2001-2014. JAMA, 315(16), 1750-1766. https://doi.org/10.1001/jama.2016.4226
15. Diez Roux, A. V. (2022). Social epidemiology: past, present, and future. Annual review of public health, 43(1), 79-98.
16. Donkin, A., Goldblatt, P., Allen, J., Nathanson, V., & Marmot, M. (2018). Global action on the social determinants of health. BMJ Global Health, 3(Suppl 1), e000603. https://doi.org/10.1136/bmjgh-2017-000603
17. Flavel, J., Freeman, T., Musolino, C., & Baum, F. (2024). Health promotion and the need to accelerate advocacy for health equity. Health Promotion International, 39(3). https://doi.org/10.1093/heapro/daae040
18. Green, H., Fernandez, R., & MacPhail, C. (2022). Well‐being and social determinants of health among Australian adults: A national cross‐sectional study. Health & Social Care in the Community, 30(6), e4345-e4354. https://doi.org/10.1111/hsc.13827
19. Hacker, K., Auerbach, J., Ikeda, R., Philip, C., & Houry, D. (2022). Social determinants of health-An approach taken at CDC. Journal of Public Health Management and Practice, 28(6), 589-594. https://doi.org/10.1097/phh.0000000000001626
20. Hacker, K., Thomas, C., Zhao, G., Claxton, J., Eke, P., & Town, M. (2024). Social determinants of health and health-related social needs among adults with chronic diseases in the United States, behavioral risk factor surveillance system, 2022. Centers for Disease Control and Prevention. Retrieved April, 10, 2026 from https://www.cdc.gov/pcd/issues/2024/24_0362.htm#
21. Hoyert, D. (2024). Maternal mortality rates in the United States, 2022. National Center for Health Statistics Health E-Stats(May 2024), 1-6. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf
22. Jackson Heart Study. (2019). About the JHS. Retrieved August 24, 2024 from https://www.jacksonheartstudy.org/About/About-The-JHS
23. Jackson Heart Study. (2022). Research Overview. Retrieved August 24, 2024 from https://www.jacksonheartstudy.org/Research
24. James, K. F., & Okoye, N. (2023). Practical strategies to overcome racial bias in nursing. Nursing for Women's Health, 27(3), 173-178. https://doi.org/10.1016/j.nwh.2023.02.003
25. Jones, D., Randall, S., White, D., Darley, L.-M., Schaefer, G., Wellington, J., Thomas, A., & Lyle, D. (2021). Embedding public health advocacy into the role of school-based nurses: addressing the health inequities confronted by vulnerable Australian children and adolescent populations. Australian Journal of Primary Health, 27(2), 67-70. https://doi.org/10.1071/PY20155
26. Kiely, B., Croke, A., Shea, M., Boland, F., Shea, E., Connolly, D., & Smith, S. M. (2022). Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open, 12(10), e062951. https://doi.org/10.1136/bmjopen-2022-062951
27. Mehdipanah, R., McVay, K. R., & Schulz, A. J. (2023). Historic redlining practices and contemporary determinants of health in the detroit metropolitan area. American Journal of Public Health, 113(S1), S49-S57. https://doi.org/10.2105/ajph.2022.307162
28. Messmer, E., Brochier, A., Joseph, M., Tripodis, Y., & Garg, A. (2020). Impact of an on-site versus remote patient navigator on pediatricians' referrals and families' receipt of resources for unmet social needs. Journal of Primary Care & Community Health, 11, 1-6. https://doi.org/10.1177/2150132720924252
29. Murdock, C. J., Laurencin, L., Christensen, D. M., & Laurencin, C. T. (2018). HIV/AIDS and the African-American community 2018: A decade call to action. Journal of Racial and Ethnic Health Disparities, 5(3), 449-458. https://doi.org/10.1007/s40615-018-0491-0
30. Nicholson, P. A. M., & Morris, D. (2021). SDOH: An emerging population health priority. Healthcare Financial Management, 75(1), 34-37.
31. Office of Disease Prevention and Health Promotion. (n.d.). Healthy people 2030: Social determinants of health. United States Department of Health and Human Services. Retrieved August 24, 2024 from https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
32. Pardo, C., McLaren, R., Jr., & Minkoff, H. (2022). Social determinants of health: The fifth vital sign. American Journal of Perinatology. https://doi.org/10.1055/a-1787-7307
33. Parliment of Australia. (2024). Child poverty. https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/PovertyinAustralia/The_extent_and_nature_of_poverty_in_Australia/Chapter_4_-_Child_poverty
34. Rangachari, P., Govindarajan, A., Mehta, R., Seehusen, D., & Rethemeyer, R. K. (2022). The relationship between social determinants of health (SDoH) and death from cardiovascular disease or opioid use in counties across the United States (2009-2018). BMC Public Health, 22(1), 1-19. https://doi.org/10.1186/s12889-022-12653-8
35. Rose, J. (2023). Federal reserve history: Redlining. Retrieved April 6, 2024 from https://www.federalreservehistory.org/essays/redlining#:~:text=The%20federal%20government%20played%20a,from%201934%20until%20the%201960s.
36. Rothstein, R. (2017, May 3). A forgotton history of how the U.S. government segregated America [Interview]. National Public Radio. https://www.npr.org/programs/fresh-air/2017/05/03/526708647/fresh-air-for-may-3-2017
37. Svalastog, A. L., Donev, D., Jahren Kristoffersen, N., & Gajović, S. (2017). Concepts and definitions of health and health-related values in the knowledge landscapes of the digital society. Croat Med J, 58(6), 431-435. https://doi.org/10.3325/cmj.2017.58.431
38. Tiase, V., Crookston, C. D., Schoenbaum, A., & Valu, M. (2022). Nurses' role in addressing social determinants of health. Nursing2023, 52(4), 32-37. https://journals.lww.com/nursing/fulltext/2022/04000/nurses__role_in_addressing_social_determinants_of.10.aspx
39. United Nations. (2020). World social report 2020: Inequality in a rapidly changing world. https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2020/01/World-Social-Report-2020-FullReport.pdf
40. United States Department of Agriculture. (2024). Farmers market nutrition program. Retrieved August 24, 2024 from https://www.fns.usda.gov/fmnp/wic-farmers-market-nutrition-program
41. United States Department of Health and Human Services. (2022, May 16). Five social determinants of health in healthy people 2030 [video]. YouTube. https://www.youtube.com/watch?v=2UK7NrHOsmA&t=65s
42. Walker, L. O., & Avant, K. C. (2019). Strategies for theory construction in nursing (6th ed.). Pearson Education.
43. World Health Organization. (2013). Social determinants of health: Key concepts. Retrieved June 30, 2024 from https://www.who.int/news-room/questions-and-answers/item/social-determinants-of-health-key-concepts
44. World Health Organization. (2018). Health inequities and their causes. Retrieved August 24, 2024 from https://www.who.int/news-room/facts-in-pictures/detail/health-inequities-and-their-causes
45. World Health Organization. (2024). Social determinants of health. Retrieved August 1, 2024 from https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
CC BY-SA 4.0 allows:
- Share: Copy and redistribute the material in any medium or format.
- Adapt: Remix, transform, and build upon the material for any purpose, even commercially.
Rules to follow:
- Attribution (BY): You must give credit to the original creator, provide a link to the license, and note if changes were made.
- ShareAlike (SA): If you remix, change, or build upon the material, you must distribute your new work under the exact same CC BY-SA 4.0 license.
