The social determinants of health and mental health were the focus of a recent APA Mental Health Equity Fireside Chat hosted by APA’s Division of Diversity and Health Equity and moderated by Division Chief and Deputy Medical Director Regina James, M.D.

Defining Social Determinants

Mario Sims, Ph.D., FAHA, chief science officer of the Jackson Heart Study and professor of medicine at the University of Mississippi Medical Center, defined the social determinants of health (SDOH) as the “conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels.” Examples include quality of education, affordability of housing, poverty, access to clean water, and perceptions/experiences of discrimination.

Sims, who has conducted extensive research on social determinants noted that individual factors, such as knowledge, skills and attitudes are at the center, followed by interpersonal factors (family, friends), organizations (schools), community, and public policy. His research has shown that there are multiple dimensions of SDOH that are critical risk factors for cardiovascular disease inequities.

Michael T. Compton, M.D, M.P.H., professor of psychiatry at Columbia University and research psychiatrist at New York State Psychiatric Institute, followed with a description of the social determinants of mental health (SDOMH): societal problems that set the stage for at least four mental health-related issues:

1. They impede the achievement of optimal mental health and wellbeing in the population.
2. They increase the risk for and prevalence of mental illnesses and substance use disorders in the population.
3. Among those with existing behavioral health disorders, they worsen course and outcomes.
4. They create health disparities and health inequities.

Compton further detailed domains of the social determinants of mental health (see full list below).

A Long History of Recognizing the Problems

The study of the impacts of social factors on health has a long history. In the 19th century, Sims noted, scholars drew attention to the increased risk of disease among the poor. Public health included social factors such as access to better housing, polluted work environments, sanitation, nutrition, and access to immunization.

W.E.B. DuBois studied Black Americans in Philadelphia during this time and the impact of social and environmental factors on infectious diseases among Black people. Poverty, low income and race were found to correlate with high prevalence of infectious diseases. His research is documented in a detailed and comprehensive sociological study of the African American people of Philadelphia, “The Philadelphia Negro: A Social Study,” published in 1899.

Food Insecurity

More than one in 10 U.S. households experienced food insecurity in 2020, according to the United States Department of Agriculture. Among households with children, nearly 15% are food insecure. In a country where we have more than enough food for everyone, this is a market, a policy and a societal failure, Compton argued. And it has a direct impact on mental health--extensive research connects food insecurity with poorer mental health and psychological distress in adults and children

Valarie Blue Bird Jernigan, Dr.P.H., M.P.H., professor of rural health, and executive director of the Center for Indigenous Health Research and Policy at Oklahoma State University, noted that food insecurity in some rural indigenous communities is near 50%.  She has worked with Native American communities to improve access to fresh food and to educate schools and students and connect communities to healthier, local, fresh foods.

Taking Action

“The fact that social factors impact our health status is not a novel concept, it has been recognized for years, but the emphasis on mental health reinforces the importance of an integrated or collaborative approach to providing quality healthcare, ” said James. Compton noted, SDOMH is a population-level concept and must be addressed at the population level through changing public policy and social norms. Sims also suggested that the negative health effects of SDOH must be mitigated through policy to accomplish health equity. At the individual level, presenters suggest clinicians can begin by screening for social determinants and connecting with primary care physicians or other healthcare professionals to identify needs. Additionally, Jernigan and her colleagues are looking toward indigenous models of health, which more typically incorporate mental health as part of overall health, rather than traditional public health.

The conversation on social determinants of mental health and addressing health inequities will continue in upcoming sessions in the APA Looking Beyond Series as we bring an interdisciplinary lens to the discussion so that we can leverage innovative frameworks to address mental health inequities.

Learn more about upcoming events in the Looking Beyond Series.