Social Determinants of Health

"Social influences can affect a person’s health even more than the quality of their medical care. We want to learn as much as possible about these factors so health care systems can effectively intervene at the level of the individual and community.”

Cara Lewis, PhD
Kaiser Permanente Washington Health Research Institute Associate Investigator

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,” says Clarissa Hsu, KPWHRI assistant 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 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 MacColl 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 and the Group Health 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 (e.g., 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

Lehavot K, Blosnich JR, Glass JE, Williams EC. Alcohol use and receipt of alcohol screening and brief intervention in a representative sample of sexual minority and heterosexual adults receiving health care. Drug Alcohol Depend. 2017 Oct 1;179:240-246. doi: 10.1016/j.drugalcdep.2017.07.003. Epub 2017 Aug 2. PubMed

Henrikson NB, Chang E, Ulrich K, King D, Anderson ML. Communication with physicians about health care costs: survey of an insured population. Perm J. 2017;21. doi: 10.7812/TPP/16-070. PubMed

McClure JB, Blasi PR, Cook A, Bush T, Fishman P, Nelson J, Anderson ML, Catz SL. Oral health 4 life: design and methods of a semi-pragmatic randomized trial to promote oral health care and smoking abstinence among tobacco quitline callers. Contemp Clin Trials. 2017 Jun;57:90-97. doi: 10.1016/j.cct.2017.04.003. Epub 2017 Apr 12. PubMed

Schoeppe J, Cheadle A, Melton M, Faubion T, Miller C, Matthys J, Hsu C. The Immunity Community: a community engagement strategy for reducing vaccine hesitancy. Health Promot Pract. 2017 Sep;18(5):654-661. doi: 10.1177/1524839917697303. Epub 2017 Apr 11. PubMed

Williams EC, Lapham GT, Shortreed SM, Rubinsky AD, Bobb JF, Bensley KM, Catz SL, Richards JE, Bradley KA. Among patients with unhealthy alcohol use, those with HIV are less likely than those without to receive evidence-based alcohol-related care: a national VA study. Drug Alcohol Depend. 2017 May 1;174:113-120. doi: 10.1016/j.drugalcdep.2017.01.018. Epub 2017 Mar 6. 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

Hsu CW, Hertel E, BlueSpruce J, Ross TR, Cheadle A, Johnson E, Matthys J, Ehrlich K, Coleman K, Tufte J, Robbins M, Fishman P. Connecting primary care patients to community resources: lessons learned from the development of a new lay primary care team role. J Patient Cent Res Rev. 2016;3:218.

Lewis CC, Marti CN, Marriott BR, Scott K, Ayer D. Patterns of practice in community mental health treatment of adult depression. Psychother Res. 2017 Mar 22:1-8. doi: 10.1080/10503307.2017.1303210. [Epub ahead of print]. PubMed

Researchers in Social Determinants of Health

Cara C. Lewis, PhD, HSPP

Associate Investigator
206-442-4076
lewis.cc@ghc.org

Curriculum vitae (CV)

Clarissa Hsu, PhD

Assistant Investigator
206-287-4276
hsu.c@ghc.org

Curriculum vitae (CV)

Leah Tuzzio, MPH

Research Associate
206-287-2109
tuzzio.l@ghc.org

Curriculum vitae (CV)

Katharine A. Bradley, MD, MPH

Senior Investigator
206-287-2151
bradley.k@ghc.org

Curriculum vitae (CV)

Paula Lozano, MD, MPH

Sr Investigator, Kaiser Permanente Washington Health Research Institute; Associate Medical Director for Research and Translation & Physician, Pediatrics, Washington Permanente Medical Group
206-884-8241
lozano.p@ghc.org

Curriculum vitae (CV)

David E. Arterburn, MD, MPH

Sr Investigator, Kaiser Permanente Washington Health Research Institute; Physician, Washington Permanente Medicial Group, Internal Medicine
206-287-4610
arterburn.d@ghc.org

Curriculum vitae (CV)

Evette J. Ludman, PhD

Senior Research Associate
206-287-2917
ludman.e@ghc.org

Curriculum vitae (CV)

Joseph E. Glass, PhD

Assistant Scientific Investigator
206-287-4266
glass.j@ghc.org

Curriculum vitae (CV)

Beverly B. Green, MD, MPH

Associate Investigator
206-287-2997
green.b@ghc.org

Curriculum vitae (CV)

Nora Henrikson, PhD, MPH

Research Associate
206-287-4675
henrikson.n@ghc.org

Curriculum vitae (CV)

Michael R. Von Korff, ScD

Senior Investigator
206-287-2874
vonkorff.m@ghc.org

Curriculum vitae (CV)

Caitlin Morrison, MPH

Research Associate
206-287-2163
morrison.caitlin@ghc.org

Curriculum vitae (CV)

Allen Cheadle, PhD

Director, Center for Community Health & Evaluation; Senior Investigator, KPWHRI
206-287-4391
cheadle.a@ghc.org

Curriculum vitae (CV)

Paula R. Blasi, MPH

Research Associate
206-287-2094
blasi.p@ghc.org

Curriculum vitae (CV)

Gwen Lapham, PhD, MPH, MSW

Research Associate
206-287-2021
lapham.g@ghc.org

Curriculum vitae (CV)

Marlaine Gray, PhD

Research Associate
206-287-2620
gray.m@ghc.org

Curriculum vitae (CV)

Gregory E. Simon, MD, MPH

Senior Investigator
206-287-2979
simon.g@ghc.org

Curriculum vitae (CV)

David C. Grossman, MD, MPH

Sr Investigator, Kaiser Permanente Washington Health Research Institute; Sr Associate Medical Director, Market Strategy & Public Policy and Physician, Pediatrics, Washington Permanente Medical Group
206-287-2948
grossman.d@ghc.org

Curriculum vitae (CV)

Andrea J. Cook, PhD

Senior Investigator
206-287-4257
cook.aj@ghc.org

Curriculum vitae (CV)

Dori E. Rosenberg, PhD, MPH

Assistant Investigator
206-287-2532
rosenberg.d@ghc.org

Curriculum vitae (CV)

Jennifer F. Bobb, PhD

Assistant Investigator
206-287-2190
bobb.j@ghc.org

Curriculum vitae (CV)

Katie Coleman, MSPH

Research Associate
206-287-2872
coleman.cf@ghc.org

Curriculum vitae (CV)

Robert Penfold, PhD

Associate Investigator
206-287-2232
penfold.r@ghc.org

Kai Yeung, PharmD, PhD

Assistant Investigator
(206) 287-2063
yeung.k@ghc.org

Curriculum vitae (CV)

Jennifer B. McClure, PhD

Director of Research, Faculty, & Development; Senior Investigator
206-287-2737
mcclure.j@ghc.org

Curriculum vitae (CV)

Michael L. Parchman, MD, MPH

Senior Investigator, MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
206-287-2704
parchman.m@ghc.org

Curriculum vitae (CV)

Affiliate researcher

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