Social Determinants of Health – Approaches to the HIV Epidemic

Table of Contents

  1. Introduction – Why viral suppression is important
  2. What are Social Determinants of Health
  3. Why address Social Determinants of Health
  4. How to address Social Determinants of Health
  5. Who should address Social Determinants of Health
  6. How to identify what Social Determinants of Health impact your community
  7. Raising awareness using social media for Social Determinants of Health
  8. Funding strategies
  9. Evaluation
  10. Webinars

Notice to Readers

This document provides an overview of Social Determinants of Health (SDH) and approaches for reducing HIV-related disparities and their collective impact on vulnerable populations. Strategies in this toolkit can be used to increase awareness and direct prevention initiatives. These examples are provided for illustrative purposes and do not constitute endorsement.

Links to organizations found in this document are provided solely as a service to the reader. These links do not constitute an endorsement of these organizations or their programs, and none should be inferred. The Texas HIV Syndicate is not responsible for the content of the individual organization sites listed in this document.

Document created February 2016

The Social Determinants of Health: Approaches to the HIV Epidemic Toolkit was prepared by The Texas HIV Syndicate: Public Awareness Priority Group with Stan Baker, Arianni Becerra, Nike Blue, Alex Byrd, Jackie Bzostek, Jeanett Deas-Calhoun, Ana Colin-Hernandez, Tom Cassady, Charlene Doria-Ortiz, Herman Finley, Nell Gaither, Helen Turner-Goldenberg, Gregg Gunter, Lionel Hillard, Ashley Innes, Marsha Jones, Markelse, Jordan, Robyn Koch, Sara Mendez, Shawna Stewart, Steven Vargas, and John Waller in association with the Texas Department of State Health Services.

PDF version of Social Determinants of Health toolkit

1. Introduction

Purpose and Intended Target Audience of the Toolkit

The purpose of the Texas HIV Syndicate is to reduce HIV infections in Texas by identifying strategies to enhance and expand work already being done across the spectrum of HIV prevention and treatment. Texas HIV Syndicate priority groups develop resources to advance the identified strategies across the state.

The Social Determinants of Health: Approaches to the HIV Epidemic Toolkit (Toolkit) is a unique resource. Rather than solely addressing communities themselves, it was developed at a state level for individuals and organizations working with and through communities.

The Toolkit is an information source which will be available to interested parties across the state. Social Determinants of Health (SDH) are defined in the toolkit and information is given on raising awareness (through social media) about the role SDH play in the spread of HIV and HIV-related disparities. The Toolkit consolidates many sources of information into one document.

Toolkit Use

While many organizations across the State of Texas have begun to address SDH in their own communities, this Toolkit is an informative guide of available resources to supplement and complement existing efforts. The Toolkit is not prescriptive. It outlines processes that can be referenced, as needed, for use to meet individual program needs.

2. What are Social Determinants of Health states that SDH are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Resources that enhance quality of life can have a significant influence on population health outcomes.” (, 2015) also notes that “our health is influenced in part by social determinants such as access to social and economic opportunities; resources and support available in our homes, neighborhoods, and communities; quality of our schooling; safety of our workplaces; cleanliness of our water, food, and air; and the nature of our social interactions and relationships.” (Healthy People 2020, 2015)

The website provides the following examples of SDH:

  • Availability of resources to meet daily needs (e.g., safe housing and local food markets)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation options
  • Public safety
  • Social support
  • Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
  • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
  • Socioeconomic conditions (e.g., concentrated poverty and accompanying stressful conditions)
  • Residential segregation
  • Language and literacy
  • Access to mass media and emerging technologies (e.g., cell phones, Internet, and social media)
  • Culture

(Healthy People 2020, 2015)

Additional SDH Resources

Centers for Disease Control and Prevention: Frequently Asked Questions

World Health Organization

Centers for Disease Control and Prevention

The Robert Wood Johnson Foundation

National Association of County and City Health Officials – Contains: Trainings, web based courses, and healthy equity tools

Equity, social determinants and public health programmes – Editors Erik Blas and Anand Sivasankara Kurup. WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.

Closing the gap in a generation: Health equity through action on the social determinants of health – Final report of the Commission on Social Determinants of Health. Geneva, 2008, World Health Organization.

Data Set Directory of Social Determinants of Health at the Local Level – Hillemeier, M., Lynch, J., Harper, S., Casper, M., Data Set Directory of Social Determinants of Health at the Local Level. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.

Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health – Brennan Ramirez LK, Baker EA, Metzler M. Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.

3. Why Address Social Determinants of Health

Addressing social factors is critical in the quest to end health disparities and understand the relationship between underlying conditions and individual choice. To improve health, we need to focus on addressing the characteristics of communities.

The following links provide information and justification for the need to address SDH.

Social Determinants of Health Solid Facts

This report by WHO contains the following SDH topics:

  • The social gradient
  • Stress
  • Early life
  • Social exclusion
  • Work unemployment
  • Social support
  • Addiction
  • Food
  • Transport

Social Determinants of Health

The 2008 Consultation Meeting Report from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) provides examples of opportunities and recommendations of future directions regarding SDH in the areas of public health policy, data systems, agency partnerships, capacity building, prevention research, and evaluation. (Prevention, 2009)

Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States - This is an NCHHSTP White Paper on Social Determinants of Health, 2010.

Social Determinants of Health – This is an article by Community Health Improvement Partners (CHIP). CHIP draws from the materials published by Phil Rabinowitz and his colleagues at the University of Kansas Community Tool Box (CTB) and provides a brief overview of the what, why, who, when and how of addressing the social determinants of health (CBT, 2010).

4. How to Address Social Determinants of Health

A New Way to Talk about Social Determinants of Health

This article from the Robert Wood Johnson Foundation (RWJF) provides guidance on how to develop messaging around SDH. It includes best practices in language, word choice, use of support data, and us of pictures to tell your stories. (2010 Robert Wood Johnson Foundation, 2015) RWJF shares the following methods for talking about Social Determinants of Health. “These proxy statements can replace the SDH descriptor and help people understand the concept more clearly.

Six Ways to Talk About Social Determinants of Health

  1. Health starts, long before illness, in our homes, schools and jobs.
  2. All Americans should have the opportunity to make the choices that allow them to live a long, healthy life, regardless of their income, education, or ethnic background.
  3. Your neighborhood or job shouldn’t be hazardous to your health.
  4. Your opportunity for health starts long before you need medical care.
  5. Health begins where we live, learn, work, and play.
  6. The opportunity for health begins in our families, neighborhoods, schools, and jobs.”

(2010 Robert Wood Johnson Foundation, 2015)

From Theory to Action: Applying Social Determinants of Health to Public Health Practice - This article written by Hazel Dean, Kim Williams, and Kevin Fenton seeks to illustrate how public health professionals can address SDH using a variety of public health activities that promote health equity among the populations most disproportionately impacted by infectious and chronic diseases.

5. Who Should Address Social Determinants of Health

Everyone involved in health-related program development must consider health issues in the context of SDH. Those affected by specific health issues, as well as those addressing those issues, should know as much as possible about its context and history, as well as who in their community might be able to address SDH.

“The University of Kansas Community Tool Box advocates for participatory approaches to planning and, in this case, for a participatory approach to analysis and intervention as well. The presence of representatives of groups affected by the issue will ensure that everyone knows its full context and history.” (KU Work Group for Community Health and Development, 2015 Chapter 17, Section 5: Addressing Social Determinants of Health and Development) Those who should be involved include:

  • Those affected by, or at risk for, a particular health condition or community development issue.
  • Policy makers, legislators, officials, or others who can influence the issue.
  • Human services staff, administrators, and others (such as police officers, teachers, and coalition members) who are responsible for dealing with the various issues.
  • Local figures, including advocates, clergy, and others, in the community to whom people turn for support.
  • Members of groups that may be asked to change, sacrifice, or act to address the issue. Employers, landlords and other property owners, health and human service workers, police, and teachers might all fall into this category.

(KU Work Group for Community Health and Development, 2015 Chapter 17, Section 5: Addressing Social Determinants of Health and Development)

Community Tool Box

This website contains a section discussing social determinants of health from the perspective of what, why, who, when and how. 

Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health

This workbook by the Center for Disease Control and Prevention is for public health practitioners and partners interested in addressing SDH and provides a fundamental perspective on who should address SDH. Section 1 of the workbook titled “Creating Your Partnership to Address Social Determinants of Health” makes the following key point:

“It is essential to build partnerships to address social determinants of health because no one group, be it health care providers, public health practitioners, or community members, can accomplish the many tasks required for changing social, economic, and environmental conditions that impact health.”
(Brennan Ramirez LK, 2015)

Additional Resources

Closing the gap in a generation: Health equity through action on the social determinants of health – 2008 WHO Commission on Social Determinants of Health: Final report/Executive summary

ACTION: SDH – Website houses SDH information and provides a platform for SDH discussion.

Tackling social determinants of health through community based initiatives – Article by M. Assai, S. Siddiqi, and S. Watts, provided by the British Medical Journal. BMJ, vol. 333, 21 October, 2006.

6. How to Identify Which Social Determinants of Health Impact Your Community

Community assessments can and should be more than gathering and analyzing data. They can also be a basis for creating change. A community-based needs assessment can help provide a snapshot of families in the service area and their economic wellbeing, educational status, health, and welfare. Recognizing and identifying community strengths and weaknesses can influence strategic planning and decision-making.

Identifying Community Assets and Resources

This approach puts a focus on community assets and strengths. Community assets and strengths can be used to meet community needs. (KU Work Group for Community Health and Development, 2015 Chapter 3, Section 8: Identifying Community Assets and Resources)

Developing a Plan for Assessing Local Needs and Resources

This website describes why you should assess needs and resources and why you should develop an assessment plan.

Strengths, Weaknesses, Opportunities, and Threats (SWOT) Analysis

A SWOT analysis can offer helpful perspectives at any stage of an effort. It can be used to:

  • Explore possibilities for new efforts or solutions to problems.
  • Assist in the decision-making process of determining the best path for your initiative, by identifying opportunities and threats to success.
  • Determine where change is possible. When at a juncture or turning point, an inventory of your strengths and weaknesses can reveal priorities and possibilities.
  • Adjust and refine plans mid-course. A new opportunity might open wider avenues, while a new threat could close a path that once existed.

(KU Work Group for Community Health and Development., 2015 Chapter 3, Section 14: SWOT Analysis: Strengths, Weaknesses, Opportunities, and Threats)

Additional SDH Resources

Mind Tools Website – Overview of SWOT

Community Tool Box – Descriptions, tools, and examples of SWOT

Health Impact Assessment (HIA) generic screening tool

Why and how to collect information – This section talks about hard data: where to get it, how to use it, and its limitations.

2-1-1 Texas: Finding Help in Texas – Resources by zip code Housing, Shelter, Food Assistance, etc.

7. Raising Awareness using Social Media for Social Determinants of Health

Message Design Strategies to Raise Public Awareness of Social Determinants of Health and Population Health Disparities

This article reviews three message strategies that could be used to raise awareness of SDH and health disparities: message framing, narratives, and visual imagery. (Niederdeppe, 2008)

Implementing a Social Marketing Effort

Some of the information included in this tool kit:

  • What is social marketing
  • Who can do social marketing
  • Why is social marketing important
  • Stages of a successful social marketing effort
  • Conducting a social marketing campaign
  • Collecting information about the problem
  • Understanding the issue
  • Conducting focus groups, interviews, public forums and listening sessions

(KU Work Group for Community Health and Development., 2015 Toolkits Section 13: Implementing a Social Marketing Effort)

Types of Campaigns

Service – An example of a service approach could be an organizer convincing neighborhood religious institutions to put cots in their basements for the homeless

Education – An example of an educational approach could be researching causes of homelessness and educating the community on this social issue.

Self-Help – An example of helping others to help themselves could be to hold workshops for homeless people that enabled them to gain new knowledge, skills, and employment.

Advocacy – An example of an advocacy approach could be lobbying for more homeless shelters and food programs. When advocating for change those affected may not be involved with the effort.

Direct Action – An example of involving groups of people to act for change could be organizing a rally protesting against the criminalization of homelessness and the dehumanizing policies toward those living without homes.

Types of Social Media Campaigns (source)

  • Photo campaigns
  • Blog Entries
  • Design campaigns
  • Video campaigns
  • Mixed media

Additional Social Media Resources

Policy Tool for Social Media – Social media policy outlines guidelines for communicating online. This tool provides a policy that can be customized for your organization.

HIV Prevention Goes Social Part II Social Media Strategy, Policy, & Monitoring Workbook

HIV Prevention Goes Social Using Social Media to Create, Connect, and Come Together

The National Minority AIDS Council – HIV Goes Social and other resources

8. Funding Strategies

10 Ways to Start a Fund for Social Good Online – provides a list and description of online tools to help bring awareness to and raise funds for a campaign.

Top 10 Crowdfunding Sites – Crowd funding is the process of collecting funds for a wide variety of purposes through a collective approach by numerous participants. This website provides a list of sites and important information to know.

The following websites announce available grant opportunities

Janssen Therapeutics Grants & Contributions

Viiv Healthcare Grants

Bristol Myers Squibb Grants

9. Evaluating Social Media

The American Evaluation Association offers a blog that includes daily posts of all things related to evaluation.

Nonprofit Social Media Decision Guide – Idealware provides a free download to their Nonprofit Social Media Decision Guide. The guide walks through a five-step process for:

  1. Understanding Social Media
  2. Defining Your Goals and Audience
  3. Evaluating Specific Tools
  4. Choosing Tools to Meet Your Goals
  5. Creating Your Social Media Strategy

10. Webinars

Social Determinants of Health: Reforming the Health System to Work Smarter, Not Harder, to eliminate Health Disparities – This webinar by the National Conference of State Legislators (NCSL) is part of their health disparity project.

Social Determinants of Health Program Planning in Public Health: What’s the evidence? – This webinar is hosted by Health Evidence. Health Evidence is an online database containing effective public health interventions and other resources.

Health Disparities and Social Determinants of Health – Webinar by Physicians for a National Health Program (PNHP)

Understanding Social Determinants of Health from the Ground Up: Taking Neighborhood Health to Heart – Webinar by Public Health Practice grounded on community based participatory research.

Social Determinants of Health – Ted Talk by Clair Pomeroy raises the issue of socioeconomics in relation to the provision of health care and treatment. Clair speaks from her viewpoint and experience as a fourteen year old surviving on the streets and various foster centers.