The five pillars

of Social Determinants of Health

The Five Pillars

of Social Determinants of Health

The five pillars of Social Determinants of Health (SDOH) represent key categories or domains of factors that collectively influence health outcomes and disparities. These pillars provide a framework for understanding and addressing the various social, economic, and environmental factors that impact individuals’ well-being. The specific categories (sub-pillars) might vary slightly based on different frameworks or models, but generally, the five pillars include:

Economic Stability:

This pillar encompasses factors related to an individual’s financial well-being. It includes aspects such as income level, employment status, job security, and access to resources like affordable housing and transportation. Economic stability plays a significant role in determining access to healthcare, nutritious food, and other essential resources that impact health.
  • Socioeconomic Status (SES):
    Income, education, and occupation are key components of SES. People with higher SES tend to have better access to healthcare, nutrition, and living conditions, leading to improved health outcomes.
  • Employment and Working Conditions:
    Job stability, work-related stress, and occupational hazards can impact health. People in stable, safe jobs with reasonable working hours generally experience better health outcomes.
  • Income and Wealth:
    A higher income allows individuals to afford quality healthcare, nutritious food, safe housing, and other resources that promote good health. Inadequate income can lead to limited access to these essentials.


Education is a fundamental determinant of health. It includes access to quality education, literacy, and educational attainment. People with higher levels of education tend to make healthier choices, have better understanding of health information, and have improved job prospects, all of which contribute to better health outcomes.
  • Early Childhood Development:
    Early experiences, including prenatal care, nutrition, and early childhood education, play a significant role in shaping long-term health outcomes

Social and Community Context:

This pillar emphasizes the importance of social connections, community support, and the overall social environment. Factors such as social networks, support systems, community cohesion, and exposure to discrimination or violence can significantly affect an individual’s mental and physical well-being.
  • Social Support Networks:
    Strong social connections with family, friends, and communities provide emotional support, reduce stress, and promote positive health behaviors.
  • Cultural and Social Norms:
    Cultural beliefs, attitudes, and social norms influence health behaviors and attitudes toward healthcare. Understanding and respecting diverse cultural perspectives are essential for providing effective healthcare.
  • Stress and Psychosocial Factors:
    Chronic stress, discrimination, and other psychosocial factors can have negative effects on physical and mental health. These factors are often more prevalent in marginalized populations.
  • Gender and Social Roles:
    Gender-based roles and expectations can influence health behaviors, access to care, and exposure to specific health risks.

Healthcare Access and Quality:

Access to healthcare services and the quality of care received are critical for maintaining good health. This pillar includes factors like healthcare coverage, affordability, availability of medical facilities, preventive services, and the cultural competence of healthcare providers.
  • Access to Healthcare:
    Adequate access to healthcare services, including medical care, preventive services, and medications, is crucial for maintaining good health. Lack of access can lead to delayed or inadequate treatment.
  • Healthcare System:
    The structure and availability of healthcare services, insurance coverage, and quality of care impact individuals’ ability to access appropriate medical treatment.

Neighborhood and Built Environment:

The physical environment in which people live has a profound impact on their health. This pillar includes factors like access to safe housing, clean air and water, green spaces, availability of healthy food options (food deserts vs. food access), exposure to environmental hazards, and overall urban planning.
  • Housing and Neighborhood:
    Safe, affordable housing in neighborhoods with access to green spaces, healthcare facilities, and healthy food options supports better health outcomes. Poor housing conditions and living in disadvantaged neighborhoods can contribute to health risks.
  • Food Security:
    Access to nutritious and culturally appropriate food is essential for maintaining good health. Food insecurity, or limited access to sufficient food, can lead to malnutrition and various health problems.
  • Physical Environment:
    Environmental factors such as air and water quality, exposure to toxins, and access to green spaces can impact health outcomes. Polluted or unsafe environments contribute to health risks.