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      Exploring consensus across sectors for measuring the social determinants of health

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          Abstract

          The importance of social determinants of health (SDOH) —such as affordable housing, stable employment, consistent transportation, healthy food access, and quality schools—is well-established as a key component of chronic disease prevention and health promotion. Increasingly, practitioners within and beyond public health are collaborating to implement such strategies, part of which involves measuring their impacts over time. This study assesses the current state of SDOH measurement across sectors by systematically identifying how many and what kinds of tools exist and whether there is consensus around SDOH categories and indicators selected.

          This study revealed that while numerous SDOH measurement resources exist, relatively few are tools for measuring the SDOH. Although the SDOH categories being measured could be readily summarized across tools, there was wide variation in the particular SDOH categories included in each tool. Finally, remarkably little consensus exists for the specific indicators used to measure SDOH categories. While complete consensus across tools may not be possible, learning how different sectors measure SDOH and more systematically aligning SDOH categories and indicators being measured will enable greater collaboration and deepen the impacts of place-based interventions to improve community health and well-being.

          Highlights

          • Growing interest exists in measuring social determinants of health (SDOH).

          • We aimed to understand the current state of SDOH measurement across sectors.

          • General consensus exists on SDOH categories included in current measurement tools.

          • However, there is wide variation in specific indicators with most used only once.

          • Collaborating beyond sectoral bounds will be critical in increasing impact.

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          Most cited references 14

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          Actual causes of death in the United States.

           J McGinnis,  W Foege (1993)
          To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and complications of vital statistics and surveillance data were also obtained. Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400,000 deaths), diet and activity patterns (300,000), alcohol (100,000), microbial agents (90,000), toxic agents (60,000), firearms (35,000), sexual behavior (30,000), motor vehicles (25,000), and illicit use of drugs (20,000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities.
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            Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities.

            There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared toward improving access, coverage, quality, and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This article highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health and on interventions in upstream factors such as housing, neighborhood conditions, and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.
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              Producing health, consuming health care

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                Author and article information

                Contributors
                Journal
                SSM Popul Health
                SSM Popul Health
                SSM - Population Health
                Elsevier
                2352-8273
                09 April 2019
                April 2019
                09 April 2019
                : 7
                Affiliations
                [a ]Build Healthy Places Network, 870 Market Street, Suite 1255, San Francisco, CA, 94102, USA
                [b ]Public Health Institute, 555 12th Street, Oakland, CA 94607, USA
                [c ]University of California, Berkeley, Department of City and Regional Planning, 228 Wurster Hall #1850, Berkeley, CA 94720, USA
                [d ]University of California, Berkeley, School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, USA
                Author notes
                []Corresponding author. krroy@ 123456berkeley.edu
                Article
                S2352-8273(19)30039-4 100395
                10.1016/j.ssmph.2019.100395
                6484213
                © 2019 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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