Analysis of social determinants of health and individual factors found in health equity frameworks: Applications to injury research

Abstract

Introduction: This research evaluated existing health equity frameworks as they relate to social determinants of health (SDOHs) and individual factors that may impact injury outcomes and identify gaps in coverage using the Healthy People (HP) 2030 key domains.

Methods: The study used a list of health equity frameworks sourced from previous literature. SDOHs and individual factors from each framework were identified and categorized into the Healthy People 2030 domains. Five injury topic areas were used as examples for how SDOHs and individual factors can be compared to injury topic-specific health disparities to identify health equity frameworks to apply to injury research.

Results: The study identified 59 SDOHs and individual factors from the list of 33 health equity frameworks. The number of SDOHs and individual factors identified varied by Healthy People 2030 domain: Neighborhood and Built Environment contained 16 (27.1%) SDOHs and individual actors, Social and Community Context contained 22 (37.3%), Economic Stability contained 10 (16.9%), Healthcare Access and Quality contained 10 (16.9%), and Education Access and Quality contained one (1.7%). Twenty-three (39.0%) SDOHs/individual factors related to traumatic brain injury, thirteen (22.0%) related to motor vehicle crashes and suicide, 11 (18.6%) related to drowning and older adult falls. Eight frameworks (24.2%) covered all HP 2030 key domains and may be applicable to injury topics.

Conclusions: Incorporating health equity into research is critical. Health equity frameworks can provide a way to systematically incorporate health equity into research. The findings from this study may be useful to health equity research by providing a resource to injury and other public health fields.

Practical applications: Health equity frameworks are a practical tool to guide injury research, translation, evaluation, and program implementation. The findings from this study can be used to guide the application of health equity frameworks in injury research for specific topic areas.

Keywords: Framework; Health equity; Healthy People 2030; Injury; Social determinants of health.

Fig. 1.. Top Three Social Determinants of Health^a and Individual Factors Most Frequently Identified in Health Equity Guiding Frameworks Categorized by Healthy People 2030 Key Domains^b-d (N =33).

^a Social determinants of health (SDOHs) are broader in scope and include the social, economic, and environmental factors that influence the health and well-being of communities. SDOHs and individual factors can be categorized in the five different domains in the Healthy People 2030 model: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. ^b Includes health equity frameworks found in Table 1. ^c Only one SDOH was categorized in the Education Access and Quality domain, therefore only one is shown. ^d Definitions for select terms: Agriculture/food production and access addresses “supply side” of food security at the national or international level and is determined by economic and physical access factors such as the level of food production, stock levels, and net trade (this includes food access, which refers to household level food security and whether individuals can obtain food, food stability, food availability, food deserts, rurality, agriculture and food production). Healthcare system factors/characteristics refers to access to quality, affordable, and timely preventive and curative health care that recognizes individual patient needs, including their health history and personal preferences. Power/Prestige refers to an imbalance in status and opportunities between populations based on factors such as race and ethnicity, gender, income, or sexual orientation. Social context/environment are factors and circumstances in the broader social setting (such as exposure to community stressors or personal/life experiences) that shape behaviors, beliefs, and/or perceptions of individuals and groups of people.