Social Determinants of Health (SDOH)

Key facts

Federal framework

Healthy People 2030, HHS Office of Disease Prevention and Health Promotion

Domains

Five, from economic stability to social and community context

Diagnosis coding

ICD-10-CM Z codes in categories Z55 to Z65

Area-level measures

Area Deprivation Index and CDC/ATSDR Social Vulnerability Index

What are social determinants of health?

Social determinants of health are the economic, social and environmental conditions that shape health outside the clinic. Income, housing, education, transportation, food access and neighborhood safety all affect how likely people are to get sick, get care and recover.

Healthy People 2030, the national health objectives framework from the Department of Health and Human Services (HHS), groups these conditions into five domains. At the individual level, the unmet needs that result, such as food insecurity or unstable housing, are often called health-related social needs.

The five SDOH domains

Healthy People 2030 organizes social determinants into:

• Economic stability: employment, income, food security and housing stability.
• Education access and quality: early childhood education, literacy and school completion.
• Health care access and quality: insurance coverage, access to primary care and health literacy.
• Neighborhood and built environment: housing quality, transportation, environmental conditions and safety.
• Social and community context: social support, discrimination, incarceration and civic participation.

How SDOH is measured in data

There are two broad approaches. Individual data comes from screening questionnaires and from ICD-10-CM Z codes (categories Z55 to Z65), which record problems such as homelessness or food insecurity on a claim or medical record. Z codes are widely underused, so their absence does not mean a need is absent.

Area data assigns neighborhood characteristics to patients by address, using indexes such as the Area Deprivation Index or census measures like poverty rates. Area measures are easy to join but describe a neighborhood, not the person.

Why SDOH matters

Health plans and accountable care organizations use SDOH data to stratify risk and target care management. Pharma and device commercial teams use it to understand adherence and access barriers in specific markets. Trial sponsors use area-level measures to plan recruitment that reaches underrepresented communities, and policy analysts use it to explain differences in outcomes that clinical data alone cannot.