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

Phelan EA, Rillamas-Sun E, Johnson L, LaMonte MJ, Buchner DM, LaCroix AZ, Anderson GL. Determinants, circumstances and consequences of injurious falls among older women living in the community. Inj Prev. 2020 Jan 15. pii: injuryprev-2019-043499. doi: 10.1136/injuryprev-2019-043499. [Epub ahead of print]. 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

Shields-Zeeman L, Lewis C, Gottlieb L. Social and mental health care integration: the leading edge. JAMA Psychiatry. 2019 Jun 19. doi: 10.1001/jamapsychiatry.2019.1148. [Epub ahead of print]. PubMed

Simon GE, Bindman AB, Dreyer NA, Platt R, Watanabe JH, Horberg M, Hernandez A, Califf RM. When can we trust real-world data to evaluate new medical treatments? Clin Pharmacol Ther. 2022 Jan;111(1):24-29. doi: 10.1002/cpt.2252. Epub 2021 May 28. PubMed

Simon GE, Platt R, Watanabe JH, Bindman AB, London AJ, Horberg M, Hernandez A, Califf RM. When can we rely on real-world evidence to evaluate new medical treatments? Clin Pharmacol Ther. 2022 Jan;111(1):30-34. doi: 10.1002/cpt.2253. Epub 2021 May 19. PubMed

Simon GE. Why integrated care already owns the future. Fam Pract. 2018 Sep 26. pii: 5107523. doi: 10.1093/fampra/cmy095. [Epub ahead of print]. PubMed

Singer AR, Coleman KF, Mahmud A, Holden E, Stefanik-Guizlo K. Assessing the feasibility of an empathic inquiry approach to social needs screening in 10 federally qualified health centers.  Perm J. 2023 Oct 13:1-7. doi: 10.7812/TPP/22.178. [Epub ahead of print]. PubMed

Tuzzio L, Wellman RD, De Marchis EH, Gottlieb LM, Walsh-Bailey C, Jones SMW, Nau CL, Steiner JF, Banegas MP, Sharp AL, Derus A, Lewis CC. Social risk factors and desire for assistance among patients receiving subsidized health care insurance in a us-based integrated delivery system.  Ann Fam Med. 2022 Mar-Apr;20(2):137-144. doi: 10.1370/afm.2774. 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)

Nora Henrikson, PhD, MPH

Associate Investigator
Nora.B.Henrikson@kp.org

Curriculum vitae (CV)

 

Affiliate researcher

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