Social Determinants of Health Policy

The mission of the American Academy of Family Physicians (AAFP) is to improve the health of patients, families, and communities by serving the needs of members with professionalism and creativity.

In their patient-centered practices, family physicians identify and address the social determinants of health for individuals and families, incorporating this information in the bio psychosocial model to promote continuous healing relationships, whole-person orientation, family and community context, and comprehensive care.

Social determinants of health are the conditions under which people are born, grow, live, work, and age. The factors that strongly influence health outcomes include a person's:

  • Access to medical care
  • Access to nutritious foods
  • Access to clean water and functioning utilities (e.g., electricity, sanitation, heating, and cooling)
  • Early childhood social and physical environment, including childcare
  • Education and health literacy
  • Ethnicity and cultural orientation
  • Familial and other social support
  • Gender
  • Housing and transportation resources
  • Linguistic and other communication capabilities
  • Neighborhood safety and recreational facilities
  • Occupation and job security
  • Other social stressors, such as exposure to violence and other adverse factors in the home environment
  • Sexual identification
  • Social status (degree of integration vs isolation)
  • Socioeconomic status
  • Spiritual/religious values

The AAFP supports the assertion that physicians need to know how to identify and address social determinants of health in order to be successful in promoting good health outcomes for individuals and populations. In preparing students for practice, medical schools must foster core competency in this patient-centric concept. Physicians in training must develop awareness of the potential obstacles patients confront when following treatment plans. Without this core competency, physicians and patients alike will be impeded by suboptimal outcomes.

Family medicine graduate medical education trains physicians to lead interdisciplinary teams to deliver patient-centered medical care. Family medicine residents develop competencies in the bio psychosocial model, cultural proficiency, evidence-based practice, quality improvement, informatics, and practice-based research. Through education on the social determinants of health during residency, family physicians learn to:

  • Identify crucial social determinants of health for their community of patients
  • Identify and partner with community resources that addresss social determinants of health
  • Consistently individualize patient care based on the patient's social determinants of health
  • Engage directly via community involvement to improve social determinants of health
  • Stay informed and act on local, state, and national policies affecting the social determinants of health of the populations that they serve.

The AAFP believes policymaking should be population based and evidence based, and should support current and future research on social determinants of health. Research conducted on social determinants of health should focus on effective interventions to reduce health in equities, including family physicians' roles in ameliorating social determinants of health.

Family physicians take a leading role in addressing the social determinants of health by partnering and collaborating with public health departments, social service agencies, and other community resources. Family physicians are integral within the continuum of care and use their skills and expertise in caring for patients across the lifespan to reach out to their communities, bridge health care gaps, and strive for better health for all. (October 2012 BOD) (2013 COD)