Social Determinants (Drivers) of Health

Social Determinants (Drivers) of Health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age. Research shows that SDOH can be more important than health care or lifestyle choices in influencing health ("Social determinants of health," 2019). Learn how to address SDOH in your practice to optimize outcomes.

Addressing social determinants of health with occupational therapy

By applying the principles and core values of the OTPF-4 and client-centered care, we can address social determinants (drivers) of health or SDoH and the intersection with occupational therapy practice settings.

Social determinants (drivers) of health

Older man and woman reading to three small children

The World Health Organization (WHO) defines social determinants of health as “non-medical factors” influencing health outcomes and conditions that shape daily living, including where people are born, grow, work, and live, as well as their age. These conditions can have a direct bearing on health disparities and inequities (WHO, 2019). Occupational therapy’s role in addressing social determinants (drivers) of health span across practice settings, including mental and behavioral health, community-based practice, children and school-based settings, adults with disabilities, and aging interventions.

Health care access and quality

Two women sitting in grass outside petting a dog

According to Healthy People 2030, many people living in the United States do not have the health care services they need for preventive care and to treat chronic conditions (U.S. Department of Health and Human Services, n.d.).

Occupational therapy practitioners can:

Recognize the impact of limited insurance coverage on quality of care.
Advocate for clients through creative ways of addressing needs and challenges and educating clients on resources and referrals.
Foster culturally inclusive care that promotes belonging.
Provide access to prevention of conditions for underserved populations and communities through a grass-roots approach.
Offer access to appropriate services and resources to address sexual health.

Decision guide on provision of services
Advocacy issues in focus
Increasing access to OT services in behavioral health
AOTA is a Healthy People 2030 Champion!

Neighborhood and built environments

Man and senior woman using a walker outside walking down the street

The neighborhoods and communities where our clients live influence their overall health and well-being. Access to available and conveniently located resources contribute to health care outcomes.

Occupational therapy practitioners can:

Ask about access to grocery stores, pharmacies, social and cultural connections, and engagement.
Offer transportation options for continued mobility.
Assess safe, accessible, and affordable housing options.
Determine availability and access to open green spaces (CDC, 2022).
Consider community livability for available services and accommodations (AARP, n.d.)

Aging in place
Innovative approaches to support productive aging
Fitness in the Parks: A Community-Based Falls Prevention Program for Older Adults
Driving & community mobility for all
Specialty conferences: Aging My Way and Connecting Community and Occupational Therapy

Social and community context

Smiling man wearing headphones around neck standing on public bus holding handrail

Factors that impact communities that are of our client’s control, such as inequitable policies, discrimination, lack of health care services, and unsafe housing options, can directly affect daily living.

Occupational therapy practitioners can:

Recognize OT's role in providing non—traditional (medical) practice models.
Seek non—health care funding sources (U.S. Department of Housing and Development (HUD), local and state grants).
Support occupational justice in policing and justice policies.
Advocate for policies that promote health and well-being for all.
Provide unhoused resources.

Mental health and well-being
Meeting the needs of our community
Social determinants of health and OT's role in novel settings
Occupational therapy addressing mental & behavioral health in non-psychiatric settings
Connecting occupational therapy and 988

Economic stability

Woman helping older woman with paperwork while sitting at table

Disparities in income, rising health care costs, and workforce concerns affect engagement and quality of life.

Occupational therapy practitioners can:

Support vocational and pre-vocational interventions.
Address food insecurity to promote nutrition and access.
Develop strategies for financial management (paying bills, routines).
Navigate medical bills and insurance barriers to service delivery.

Work & Industry Special Interest Section (WISIS)
Transitions Community of Practice
Early skills vocational program
Converge Oregon: A supported education pilot program

Education and access quality

Group of children holding hands with focus on smiling girl

Interventions that level the playing field in education for children and youth benefit the entire community. Our profession plays a vital role in supporting our youngest clients and collaborating with family support and other professionals. As our workforce grows, it is important that our profession mirrors the clients and communities we serve.

Occupational therapy practitioners can:

Advocate for your role in mental health in school-based, early education, and community programs.
Assess children and youth for changes in behavior during therapy sessions.
Infuse justice, diversity, equity, and inclusion (JEDI) curricula into higher education.
Develop and advocate for pipeline opportunities that foster diverse and equitable representation.

Diversity, equity, and inclusion in OT
Path to leadership for the school-based practitioner
New allied health workforce diversity program

AOTA Official Documents

Use AOTA Official Documents to help guide education, practice, advocacy, and policy on behalf of the profession.

Position Statement

Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice

Position Statement

Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence

Societal Statement

AOTA's Societal Statement on Livable Communities

Societal Statement

AOTA's Societal Statement on Health Literacy

Societal Statement

AOTA’s Societal Statement on Health Disparities

Societal Statement

AOTA’s Societal Statement on Community Violence

Professional Policies

Occupational Therapy’s Commitment to Sustainability and Climate Change

Healthy People 2030

AOTA is a proud champion of the Healthy People 2030 initiative. This initiative provides evidence-based resources and national objectives for each SDOH domain: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment.

Identifying Social Needs

Identifying social needs starts at evaluation with a comprehensive Occupational Profile to identify social needs influencing occupations. Some organizations may also recommend the use of a social needs screening tool or standardized health-related social needs screening (HRSN). Performance-based and environmental assessments can also provide vital information related to the impact of SDOH.

Occupational therapy practitioners can address social determinants (drivers) of health at the person, group, and population level.

Resources

Review resources to learn more about SDOH and guide decision making for intervention, assessment, and treatment.

AOTA Infographic

Evolving Occupational Therapy Response to Societal Needs

AOTA Everyday Evidence Podcast

Social Determinants of Health and OT's Role in Novel Settings

SDOH Screening

Agency for Healthcare Research and Quality (AHRQ) SDOH & Practice Improvement

Centers for Medicare & Medicaid Services (CMS)

Improving the Collection of SDOH Data with ICD - 10 CM Z Codes

SAMHSA

Incorporating the Social Determinants of Health into Substance Use Prevention

The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community

Our Epidemic of Loneliness and Isolation

Research and Articles

Expand your knowledge with the latest research, perspectives, and solutions from occupational therapy practitioners.

AJOT

Two women studying at laptop inside library with others in the background

Outcomes and Investigation of the Fusion of Social Determinants of Health into Interprofessional Education

Limitations on Participation and Their Relation to Social Determinants of Health Among Occupational Therapists and Occupational Therapy Students During Coronavirus Lockdown

Social Determinants of Health: Opportunity for Occupational Therapy

SIS Quarterly

Two men wearing face masks and jumpsuits working inside a factory with others working in the background

Impacts of social determinants of health on work

Occupational therapy practitioners as advocates for health equity: Addressing social determinants of health

OT Practice

Two senior men sitting next to each other in public bus

Navigating public transportation: OT's role in SDoH

Interventions to address stroke social determinants of health

Identifying social determinants (drivers) of health using AOTA's occupational profile template

References

Braveman, B., Gupta, J., & Padilla, R. (2013, November 1). AOTA’s societal statement on health disparities. American Occupational Therapy Association. https://doi.org/10.5014/ajot.2013.67S7

Social determinants of health. (2019, May 30). World Health Organization (WHO).

Social determinants of health. (n.d.). Home of the Office of Disease Prevention and Health Promotion - health.gov.

Elevate Your Practice

Education & Career

Publications

Community

Events

Advocacy

About

Social Determinants (Drivers) of Health

Addressing social determinants of health with occupational therapy

AOTA Official Documents

Inclusive Environments: Home, Work, Public Spaces, Technology, and Specialty Environments within Occupational Therapy Practice

Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence

AOTA's Societal Statement on Livable Communities

AOTA's Societal Statement on Health Literacy

AOTA’s Societal Statement on Health Disparities

AOTA’s Societal Statement on Community Violence

Occupational Therapy’s Commitment to Sustainability and Climate Change

Healthy People 2030

Identifying Social Needs

Resources

Evolving Occupational Therapy Response to Societal Needs

Social Determinants of Health and OT's Role in Novel Settings

Agency for Healthcare Research and Quality (AHRQ) SDOH & Practice Improvement

Improving the Collection of SDOH Data with ICD - 10 CM Z Codes

Incorporating the Social Determinants of Health into Substance Use Prevention

Our Epidemic of Loneliness and Isolation

Research and Articles

References