Social Determinants of Health

Sq  Health Impact

Where does health begin?

It starts in our homes, schools, workplaces, neighborhoods, and communities. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live – the social determinants of health – explain in part why some individuals are healthier than others.

The Healthy People 2020 Social Determinants of Health framework highlights the importance of addressing these social determinants by creating social and physical environments that promote good health for all. By putting into practice what we know about the social determinants of health, we can not only improve individual and population health, but also advance health equity.

For more information about NACCHO's partnership with Healthy People, please see our Healthy People 2020 project page.

With support from the Office for State, Tribal, Local and Territorial Support within the Centers for Disease Control and Prevention (CDC), the National Association of County and City Health Officials (NACCHO) developed a training/technical assistance package to assist rural health departments in applying a SDOH lens to their community health improvement planning (CHIP) work. Through interviews with health departments, NACCHO identified two areas in which rural local health departments (LHDs) needed additional support: partnership evaluation and communications.

NACCHO awarded 6 LHDs with $15,000 to put towards their CHIP. Each site received the technical assistance package, including an in-person training in Washington, DC.

The TA package piloted with these 6 rural health departments is free for public use. Below are the new partnership evaluation and communications resources created through this project.

Under "Additional Resources," other resources identified through an environmental scan are organized by core competencies and training topics as defined below. While these resources were identified with rural local health departments in mind, the resources below can help any local public health system to address the social determinants of health.

Burness tools for crafting effective messages and stories

NACCHO Resources

Frameworks Institute

Framing Healthy Communities: Strategic Communications and the Social Determinants of Health. Details the results of experiments conducted as part of a larger study of health communications research funded by The California Endowment and the W. K. Kellogg Foundation. This study aims to understand and produce better ways to engage the public in thinking about health outcomes as a result of social and environmental factors.

Robert Wood Johnson Foundation

A New Way to Talk About the Social Determinants of Health

Culture of Health Prize Winners

Below are videos and webinars you can use to educate yourself and others about the concept of social determinants of health

Social Determinants of Health: an Introduction

Michael Marmot and the Social Determinants of Health

The Colorado Trust Health Equity Learning Series

  • Telling the Health Equity Story (2014): Laura Frank, president and general manager of news for Rocky Mountain PBS, and Llewellyn Smith, director of media for production at BlueSpark Collaborative, presented how they have told the story of health disparities through video, print and photos, as well as the importance of sharing compelling health equity stories.

Human Impact Partners

Public Health Institute

Building Healthy Places Network

Allies for Reaching Community Health Equity

Health Equity Stories

Webinars and Videos

The table below can be sorted by core competency and training topic. The core competencies are based on the domains within the Core Competencies for Public Health Professionals. Below are the training topics included for classification:

Communicating the Importance of Health Equity and the Social Determinants of Health

Knowing how to discuss the social determinants of health and health equity in different settings can help local health departments establish new partnerships and gain the support of the community or other sectors. In order to do this, local health departments need to understand the specific goals of their audience and tailor the discussion so that the audience can see the value of this work.

Designing Effective Meetings

Meetings that are productive and engaging can help maintain partnership buy-in and accomplish action plan goals. Local health departments need tools and strategies that teach them how to encourage attendee participation, both in person and online, and leave meetings with specific next steps and action items.

Organizing and Engaging Partners

Cultivating lasting community partnerships is a necessary step towards addressing health outcomes. When searching for new connections, local health departments should identify their current strengths and relationships as well as any existing gaps in capacity. As time goes on, it is important for local health departments to evaluate the effectiveness of these partnerships in accomplishing their goals for the community.

Defining Strategic Issues and Creating an Action Plan

In order to improve health outcomes, local health departments will need to understand their root causes and develop plans that seek to address those causes. Health departments need tools and templates that help them to identify short/long term goals and develop measures and objectives for addressing the social determinants of health in their communities.

Evaluation

Conducting an evaluation helps to determine if a program, policy, or partnership is helping a local health department effectively accomplish their goal of addressing the social determinants of health. Self-assessments, partnership evaluations, and surveys are all useful evaluation tools.

Working with a Commitment to Health Equity

In order to effectively improve health outcomes, local health departments need to focus on the root causes of health issues. These tools help enhance general understanding of health equity concepts. They also identify strategies for maintaining a focus on health equity throughout the CHA/CHIP process and strategies for assessing competencies, and trainings that enhance understanding of health equity concepts.

Resource Core competency area Topic
Framing Healthy Communities: Strategic Communications and SDOH Communicating about Health Equity and SDOH Communication
A New Way to Talk About the Social Determinants of Health Communicating about Health Equity and SDOH Communication
NACCHO Strategic Messaging Guide Communicating about Health Equity and SDOH Communication
RWJF Culture of Health Prize Winner Stories Communicating about Health Equity and SDOH Leadership and Systems Thinking
Webinar slides from "Facilitating meetings of diverse groups of people" Designing Effective Meetings Leadership and Systems Thinking
Technology of Participation (TOP) Facilitation Methods training Designing Effective Meetings Leadership and Systems Thinking
Improving health through intersectoral collaboration Organizing and Engaging Partners Community Dimensions of Practice Skills
Enhancing effective partnerships for health equity Organizing and Engaging Partners Community Dimensions of Practice Skills
HRIA partnership recruitment tool Organizing and Engaging Partners Leadership and Systems Thinking
Evaluation guide: Fundamentals of evaluating partnerships Organizing and Engaging Partners Policy Development and Program Planning
Assessing your collaboration: A self-evaluation tool Organizing and Engaging Partners Policy Development and Program Planning
Community Health Improvement Toolkit with Prioritization tool for ranking/rating key health issues and Logic model template Defining Strategic Issues and Creating an Action Plan Analytical and Assessment Skills
Community Health Improvement Matrix template & definitions and Addressing SDOH through the Community Health Improvement Matrix Defining Strategic Issues and Creating an Action Plan Analytical and Assessment Skills
Essentials for Childhood: Steps to create safe, stable nurturing relationships and environments Defining Strategic Issues and Creating an Action Plan Analytical and Assessment Skills
HIP-Cuyahoga Key Priority: Eliminating Structural Racism Defining Strategic Issues and Creating an Action Plan Analytical and Assessment Skills
Health Resources in Action-Action planning tool Defining Strategic Issues and Creating an Action Plan Policy Development and Program Planning
Community Commons Community Health Needs Assessment Tools Defining Strategic Issues and Creating an Action Plan Policy Development and Program Planning
Using Evidence-based Strategies in Your Violence Prevention Efforts Defining Strategic Issues and Creating an Action Plan Policy Development and Program Planning
Rural Data Explorer with Rural health data guides by state Defining Strategic Issues and Creating an Action Plan Resource Guides and Data Libraries
BARHII organizational self-assessment toolkit Conducting Effective Evaluations Policy Development and Program Planning
Basic Guide to Program Evaluation Conducting Effective Evaluations Policy Development and Program Planning
CDC Evaluation Framework Conducting Effective Evaluations Policy Development and Program Planning
CDC Evaluation of State Nutrition Physical Activity, and Obesity Plans Conducting Effective Evaluations Policy Development and Program Planning
Resources for assessing and measuring SDOH Conducting Effective Evaluations Resource Guides and Data Libraries
NACCHO’s Health Equity page featuring the Roots of Health Inequity Course Working with a Commitment to Health Equity Analytical and Assessment Skills
Bay Area Regional Health Inequities Initiative (BARHII) Framework and BARHII's archived webinar on how local government can advance racial equity Working with a Commitment to Health Equity Analytical and Assessment Skills
Social Determinants of Health in your community: A worksheet for selecting SDOH indicators Working with a Commitment to Health Equity Analytical and Assessment Skills
CDC Social Determinants of Health page and CDC's Promoting Health Equity: A Resource to Help Communities Address SDOH Working with a Commitment to Health Equity Policy Development and Program Planning
CDC: Paving the Road to Health Equity Working with a Commitment to Health Equity Policy Development and Program Planning
Advancing Health Equity in LHDs: Webinar Series from Health Impact Partners Working with a Commitment to Health Equity Policy Development and Program Planning
Prevention Institute's Health Equity Toolkit including Module 3: Community Factors & How They Influence Health Equity Working with a Commitment to Health Equity Policy Development and Program Planning
Ten Essential Public Health Services: How they can include addressing social determinants of health inequities Working with a Commitment to Health Equity Policy Development and Program Planning
Public Health Reports: Applying Social Determinants of Health to Public Health Practice Working with a Commitment to Health Equity Policy Development and Program Planning
Prevention Status Reports (PSRs) highlighting the status of public health policies and practices in all 50 states and DC Working with a Commitment to Health Equity Policy Development and Program Planning
Best Practices User Guide: Health Equity in Tobacco Prevention and Control Working with a Commitment to Health Equity Policy Development and Program Planning
HealthEquityGuide.org strategic practices for LHDs Working with a Commitment to Health Equity Policy Development and Program Planning
Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities Working with a Commitment to Health Equity Policy Development and Program Planning
CDC's guide to Advancing Health Equity: Community strategies for preventing chronic disease Working with a Commitment to Health Equity Policy Development and Program Planning
Allies for Reaching Community Health Equity Working with a Commitment to Health Equity Policy Development and Program Planning
Health in All Policies: A Guide for State and Local Governments Working with a Commitment to Health Equity Policy Development and Program Planning
Minnesota Department of Health Equity Resource Library Working with a Commitment to Health Equity Resource Guides and Data Libraries
NACCHO Compendium of Resources for Social Determinants of Health Indicators Working with a Commitment to Health Equity Resource Guides and Data Libraries
Public Health Reports: Data Systems and Social Determinants of Health Working with a Commitment to Health Equity Resource Guides and Data Libraries
Rural Health Disparities and Social Determinants of Health for Rural People Working with a Commitment to Health Equity Resource Guides and Data Libraries