Social Determinants of Health: How Our Lives Determine Our Wellbeing 

Updated on March 10, 2023
healthy aging male

The constitution of the World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” In other words, health is more than just not being sick. While this should not be a revelatory idea…somehow it is. We have convinced ourselves that not being broken is the same thing as being well, all the while bypassing the common wisdom (exercising, eating right, getting a good night’s sleep) and overlooking the social drivers (income, education, access to healthcare, neighborhood, and community) that contribute to our overall health and wellness. 

How the social drivers of health are steering wellness

Social drivers – often called the social determinants of health – are pre-existing conditions in your life that impact your ability to become and stay well. And almost all of them happen outside of the doctor’s office. The social determinants of health include your income or economic status, education level and literacy, employment and working conditions, experiences and learnings from your childhood, and the physical environments you live in – your home, your neighborhood, and your greater community. They also include your social network and support system, your own coping mechanisms, and your access to affordable and quality healthcare. These issues are complex and symbiotic in nature, often causing, exacerbating, or feeding on one another. Income level, for example, is known to impact eating habits. Stress levels, social interactions, exercise, and access to healthcare: pick any one determinant on the list and it will link back to the others. 

What’s more is that 30 years of America’s Health Rankings from the United Health Foundation have time and again shown that health outcomes are generated based on a variety of factors: clinical care, policy, behaviors, and community and environment. Importantly, two of these fall squarely within the social determinants of health.

These social drivers are present in every aspect of our lives, and are so critical to the foundation of wellness that scientists believe they account for roughly 80% of our overall health.  This, in turn, means only 20 percent of our health is determined by what happens once inside a doctor’s office. Astounding as this may be, it highlights the critical importance of coordinated care that acknowledges, includes, and properly manages all of the determinants of health, whether they are social, clinical, or policy driven.

How communities are reframing healthcare and positively reshaping social drivers

The communities and social support networks in which we live our lives can provide significant resources for health and wellness. But there can be gaps between the resources already allocated and the resources required to help all those in need. What’s more, these gaps often result in increased health inequities and risks for older Americans aged 65 and over. That’s why community health workers, local health advocates and licensed local agents, like those who work for my own company, Advocate Health Advisors, are critical in creating and maintaining positive health outcomes in their local communities. Community health workers partner with food pantries and other services to ensure the distribution of regular, healthful meals to older community residents who may be homebound. Health advocates spend their days educating the community to increase general health literacy. 

And perhaps surprisingly, new Medicare plans are helping pave this last mile of need, allowing licensed local agents to build healthcare packages based in wellness that address many of the social determinants of health. These new options may allow local agents to aid with food and transportation or recommend the doctors who best serve the community and will make the best fit for them. 

Like community health workers and health advocates, local agents also go out into the community to find those who are most vulnerable and provide them with a solid social foundation for health and wellness by helping them navigate the financial, clinical, and social challenges associated with our healthcare system. They, along with community health workers and health advocates, become like architects, building and strengthening the health and wellness of their communities, while empowering both older Americans and others in the community to do the same for themselves. 

Working together with our communities, health professionals of all backgrounds can make a difference. Providing food, transportation, activity, education and health literacy, access to quality healthcare, strong social networks and support systems fill gaps in healthcare and once provided, have the power to resolve for many of the most burdensome health inequities. The resources are there, and all health professionals have the opportunity and responsibility to help patients and the community find and access them. More importantly, a strong community working together can achieve true health, where social determinants of health increase individual health rather than detract from it. 


1 Constitution of WHO, Definition of Health: 

2 Social Determinants of Health and Related Inequalities: Confusion and Implications, authored by M Mofizul Islam at the Department of Public Health at La Trobe University in Melbourne, AUS. 

3 America’s Health Rankings,

4 County Health Rankings,, a study supported by the Population Health Institute at the University of Wisconsin-Madison which confirms that 80% of health happens outside of a doctor’s office. 

5 The Future of Healthcare is Outside the Doctor’s Office, Governing. 

Darwin New 1 copy
Dr. Darwin Hale

Dr. Darwin Hale is Founder CEO of Advocate Health Advisors.