Social Determinants of Health

Research overview

Social, economic, and behavioral factors can influence the trajectory of one’s health so significantly they have been coined the “social determinants of health” or SDoH. Those factors include:

  • Personal characteristics such as race, ethnicity, culture, sex, gender identity, and sexual preference
  • Economic resources such as educational attainment, employment, income, wealth, and housing
  • Built environment such as transportation systems, access to healthy foods, and walkability
  • Adverse experiences such as childhood trauma, interpersonal violence, relationship disruption, or bereavement

Researchers at Kaiser Permanente Washington Health Research Institute (KPWHRI) are committed to understanding how the health care system can best identify, understand, and appropriately respond to these factors to improve the health of our members and our communities.

“Through our evaluation and research, we hope to help empower patients to better manage the social and behavioral factors that influence their health,” said Clarissa Hsu, PhD, KPWHRI associate investigator.

Our institute researchers have long been interested in SDoH. Examples include our work in areas such as tobacco addiction and the integration of treatment for behavioral health issues into primary care. We’ve worked on efforts such as reducing racial disparities in care, opioid overuse, and vaccine hesitancy. Our Center for Community Health and Evaluation has helped to promote and sustain healthy communities; our Center for Accelerating Care Transformation (formerly known as the MacColl Center for Health Care Innovation) has championed the Chronic Care Model and has been committed to helping U.S. primary care practices — including community health centers — integrate community resources into health improvement.

Moving forward, we intend to make targeted improvements in the lives of Kaiser Permanente members, but, as these examples suggest, we also work in communities around the nation for broad impact. Here are just a few examples of KPWHRI’s current work related to SDoH:

  • Moving to Health
    This project is designed to pinpoint what matters most about individual neighborhoods for their residents’ health. Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, researchers will track individuals and the built environment in their neighborhoods to see how changing communities affects factors such as people’s long-term weight and blood sugar — and whether they develop diabetes.
  • LINCC (Learning to Integrate Neighborhoods and Clinic Care)
    Researchers on this project, funded by the Patient-Centered Outcomes Research Institute, are testing how adding a community resource specialist role in primary care can help connect people with community resources that support health and wellness.
  • Team-based opioid management
    The goal of this project is to improve safe prescribing and chronic opioid medication for patients with non-cancer pain in rural primary care clinics across Washington and Idaho. Led by KPWHRI’s Center for Accelerating Care Transformation (ACT Center), the project is helping clinics develop policies, workflows, registries, tool kits, and other resources to better support patients with chronic pain. The work is funded by the Agency for Healthcare Research and Quality.
  • Addressing financial hardship
    In projects funded by the Robert Wood Johnson Foundation, a team of KPWHRI researchers is learning how health care systems can do a better job of talking transparently with patients about the cost and value of their health care. The goal is to help identify “best practices” for making tools and resources part of regular workflows in clinics. Doing so could ultimately help patients have a better understanding of what their care will cost — information that’s important for helping individuals make informed decisions about treatment based on their own values.

KPWHRI researchers are committed to gaining a holistic understanding of people’s lives — one that can best inform prevention, intervention, and implementation efforts, maximizing the public health impact of our efforts.

KPWHRI researchers have a unique constellation of methodological strengths — including qualitative analysis, implementation science, and experience with evidence reviews, evaluation design and methods, measurement development, big data analysis for community intervention evaluation, pragmatic trials, user-centered design, survey research, and community-based participatory research. These strengths are coupled with substantive expertise (for example, nutrition, physical activity, behavioral health, economic and racial disparities, prevention and health promotion, child health and development, and stigma), and a multi-disciplinary, team-science-based approach that is needed to tackle these “thorny issues.”

We hope to realize the optimal role of the health care system in addressing social, economic, and behavioral needs, and partner with the community to create much needed change.

Recent publications on Social Determinants of Health

Angier H, Huguet N, Marino M, Green B, Holderness H, Gold R, Hoopes M, DeVoe J. Observational study protocol for evaluating control of hypertension and the effects of social determinants. BMJ Open. 2019 Mar 15;9(3):e025975. doi: 10.1136/bmjopen-2018-025975. PubMed

Schrager SM, Arthur KC, Nelson J, Edwards AR, Murphy JM, Mangione-Smith R, Chen AY. Development and validation of a method to identify children with social complexity risk factors. Pediatrics. 2016 Sep;138(3):e20153787. doi: 10.1542/peds.2015-3787. Epub 2016 Aug 11. PubMed

Adami G, Saag KG, Mudano AS, Rahn EJ, Wright NC, Outman RC, Greenspan SL, LaCroix AZ, Nieves JW, Silverman SL, Siris ES, Watts NB, Miller MJ, Ladores S, Curtis JR, Danila MI. Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment. Osteoporos Int. 2020 Feb 4. pii: 10.1007/s00198-020-05312-4. doi: 10.1007/s00198-020-05312-4. [Epub ahead of print]. PubMed

Allen P, Pilar M, Walsh-Bailey C, Hooley C, Mazzucca S, Lewis CC, Mettert KD, Dorsey CN, Purtle J, Kepper MM, Baumann AA, Brownson RC. Quantitative measures of health policy implementation determinants and outcomes: a systematic review. Implement Sci. 2020 Jun 19;15(1):47. doi: 10.1186/s13012-020-01007-w. PubMed

Arthur KC, Lucenko BA, Sharkova IV, Xing J, Mangione-Smith R. Using state administrative data to identify social complexity risk factors for children. Ann Fam Med. 2018 Jan;16(1):62-69. doi: 10.1370/afm.2134. PubMed

Berry AB, Lim CY, Liang CA, Hartzler AL, Hirsch T, Ferguson DM, Bermet ZA, Ralston JD. Supporting collaborative reflection on personal values and health. Proc ACM Hum Comput Interact. 2021 Oct;5(CSCW2):1-39. doi: 10.1145/3476040. Epub 2021 Oct 18. PubMed

Brandzel S, Chang E, Tuzzio L, Campbell C, Coronado N, Bowles EJ, Bradford SC, Buist DS. Latina and Black/African American women's perspectives on cancer screening and cancer screening reminders. J Racial Ethn Health Disparities. 2016 Nov 18. [Epub ahead of print]. PubMed

Brown MC, Hawley C, Ornelas IJ, Huber C, Best L, Thorndike AN, Beresford S, Howard BV, Umans JG, Hager A, Fretts AM. Adapting a cooking, food budgeting and nutrition intervention for a rural community of American Indians with type 2 diabetes in the North-Central United States. Health Educ Res. 2023 Jan 20;38(1):13-27. doi: 10.1093/her/cyac033. PubMed

Researchers in Social Determinants of Health

Clarissa Hsu, PhD

Associate Investigator
206-287-4276
Clarissa.W.Hsu@kp.org

Curriculum vitae (CV)

Katharine A. Bradley, MD, MPH

Senior Investigator
206-287-2151
Katharine.A.Bradley@kp.org

Curriculum vitae (CV)

Paula Lozano, MD, MPH

Senior Investigator; Director, ACT Center
206-287-2113
Paula.Lozano@kp.org

Curriculum vitae (CV)

David E. Arterburn, MD, MPH

Senior Investigator
206-287-4610
David.E.Arterburn@kp.org

Curriculum vitae (CV)

Joseph E. Glass, PhD, MSW

Associate Investigator
206-287-4266
Joseph.E.Glass@kp.org

Curriculum vitae (CV)

Beverly B. Green, MD, MPH

Senior Investigator
206-287-2997
Bev.B.Green@kp.org

Curriculum vitae (CV)

Allen Cheadle, PhD

Senior Investigator, KPWHRI; Senior Research Associate, CCHE
206-287-4391
Allen.D.Cheadle@kp.org

Curriculum vitae (CV)

Paula R. Blasi, MPH

Collaborative Scientist
206-287-2094
Paula.R.Blasi@kp.org

Curriculum vitae (CV)

Gwen Lapham, PhD, MPH, MSW

Assistant Investigator
206-287-2021
Gwen.T.Lapham@kp.org

Curriculum vitae (CV)

Marlaine Figueroa Gray, PhD

Assistant Investigator
206-287-2620
Marlaine.S.Figueroagray@kp.org

Curriculum vitae (CV)

Gregory E. Simon, MD, MPH

Senior Investigator
206-287-2979
Gregory.E.Simon@kp.org

Curriculum vitae (CV)

Andrea J. Cook, PhD

Senior Biostatistics Investigator
206-287-4257
Andrea.J.Cook@kp.org

Curriculum vitae (CV)

Dori E. Rosenberg, PhD, MPH

Senior Scientific Investigator
206-287-2532
Dori.E.Rosenberg@kp.org

Curriculum vitae (CV)

Jennifer F. Bobb, PhD

Associate Biostatistics Investigator
206-287-2190
Jennifer.F.Bobb@kp.org

Curriculum vitae (CV)

Katie Coleman, MSPH

Director, ACT Center
206-287-2872
Katie.F.Coleman@kp.org

Curriculum vitae (CV)

Robert Penfold, PhD

Senior Investigator
206-287-2232
Robert.B.Penfold@kp.org

Curriculum vitae (CV)

Jennifer B. McClure, PhD

Director, Investigative Science
206-287-2737
Jennifer.B.Mcclure@kp.org

Curriculum vitae (CV)

Leah K. Hamilton, PhD

Senior Collaborative Scientist
206-287-2515
Leah.K.Hamilton@kp.org

Curriculum vitae (CV)

Jess Mogk, MPH

Collaborative Scientist
Jessica.M.Mogk@kp.org

Curriculum vitae (CV)

Claire Allen, MPH

Manager, Collaborative Science
Claire.L.Allen@kp.org

Curriculum vitae (CV)

Morgan Justice, MA

Collaborative Scientist
Morgan.J.Fuoco@kp.org

Curriculum vitae (CV)

Nicole M. Gatto, PhD, MPH

Principal Collaborative Scientist
Nicole.M.Gatto@kp.org

Curriculum vitae (CV)

Kelsey Stefanik-Guizlo, MPH

Collaborative Scientist
kelsey.i.stefanik-guizlo@kp.org

Curriculum vitae (CV)

Theresa E. Matson, PhD, MPH

Collaborative Scientist
Tessa.E.Matson@kp.org

Curriculum vitae (CV)

Meagan C. Brown, PhD, MPH

Assistant Investigator
Meagan.C.Brown@kp.org

Curriculum vitae (CV)

Linda K. McEvoy, PhD

Senior Investigator
Linda.K.Mcevoy@kp.org

Curriculum vitae (CV)

Kimberly Arthur, MPH

Collaborative Scientist
Kim.C.Arthur@kp.org

Curriculum vitae (CV)

 

Affiliate researcher

Emily Williams, PhD, MPH
University of Washington School of Public Health