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It’s tempting to think solely about medical care when discussing what makes people healthy or unhealthy. However, the Social Determinants of Health (SDOH) shape our health long before we enter a hospital or clinic. Along with their emerging digital counterpart, the Digital Determinants of Health (DDoH), Social Determinants of Health (SDoH) significantly impact our health.
Recent studies estimate that approximately 10% of health outcomes are driven solely by the quality and availability of traditional healthcare. In comparison, 50% or more are due to social determinants, factors that quietly embed themselves into our everyday lives. (1) (2)
Let’s explore these powerful forces, where they intersect, and why they demand our attention now more than ever.
Defining the Determinants
What are the Social Determinants of Health (SDoH)?
SDoH refers to the non-medical factors influencing health outcomes, such as where people are born, grow, work, live, and age. These include economic factors, educational level, ethnicity, race, gender, community, and social conditions that collectively shape health and quality of life.
They are not abstract concepts. From income and housing stability to access to education and community support, SDoH affect everything from stress levels to the risk of chronic diseases. According to the WHO, “People in the country with the highest life expectancy will, on average, live 33 years longer than those living in the country with the lowest life expectancy“(3), and SDoH factors are significant causative factors for those differences.
What are the Digital Determinants of Health (DDoH)?
Digital Determinants of Health are emerging as a vital complement to social determinants that highlight how digital access and use affect an individual’s ability to achieve good health. As healthcare increasingly transitions online through telehealth, patient portals, mobile apps, and AI diagnostics, patients’ ability to access, understand, and benefit from digital tools becomes crucial.
These determinants encompass digital literacy, internet access, user-friendly health platforms, and trust in digital systems. These factors directly influence how effectively individuals can engage with health services. Discover how advanced digital health systems are already achieving this in our blog: Detecting Disease Before Symptoms Appear.
Why are determinants of health important, and how do they impact healthcare?
Social determinants
SDoH are critical because they can significantly affect a patient’s health long before a clinical interaction occurs. Take the example of a patient with uncontrolled asthma living in damp housing or someone skipping medication due to financial stress. A large number of well-conducted studies link the social determinants to issues like:
- High-risk pregnancies
- Early hospital readmissions
- Chronic disease vulnerability
- Mental health stressors
- Health literacy gaps
If left unaddressed, these challenges accumulate across time and even generations.
Digital Determinants
Digital healthcare promises greater reach, speed, and personalisation, but only if people can access the necessary services. Gaps in digital access can exacerbate existing inequities. An older adult unfamiliar with health apps or a rural family without Wi-Fi may be deprived of life-saving care simply because they are unaware of its existence or its relevance to their condition.
As we develop more intelligent systems, we must ensure they are inclusive, equitable, and accessible to everyone. Otherwise, the tools designed to bridge care gaps may not achieve their desired outcome.
Real-World Examples of SDoH Impacting Health
- Economic stability: The inability to afford healthy food leads to a poor diet and an increased risk of chronic illness.
- Housing and environment: Overcrowded, mouldy homes increase the risk of respiratory illness and other contagious infections.
- Education: Low educational status is strongly associated with low health literacy, which can delay care-seeking and reduce adherence to prescribed treatments.
- Transportation: Missed appointments due to unreliable transport.
- Social stressors: Stress from social challenges, including family tension, job loss, or financial concerns, can lead to a myriad of clinical manifestations, such as presenting to primary care providers with new problems and exacerbations of existing ones.
A promising frontier in healthcare involves using integrated, non-clinical data such as utility bills, mortgage defaults, and educational history to develop social determinant-based risk scores. These tools help to surface hidden needs and enable targeted interventions.
For a deeper dive into how these factors appear in everyday healthcare, like how transportation, income, or education levels affect patient outcomes, check out our blog on The Importance of Social Determinants of Health.
Real-world examples of Digital Determinants of Health
- Connectivity: A patient in a remote community misses out on virtual consultations.
- Digital literacy: Patients may struggle to navigate portals or apps, especially if their developers did not carefully consider patient end users’ varying needs and skill levels.
- Device access: An absence of smartphones, computers, or tablets hinders engagement with digital services.
- Platform design: If developers do not build their solutions with accessibility in mind, they may inadvertently exclude a significant number of users who lack the necessary skills.
When health is inherently digital, digital exclusion turns into health exclusion.
Empowering Clinicians to Act
Clinicians may recognise and address both social and digital barriers through a growing practice known as social prescribing. Social prescribing involves:
- Actively asking about a patient’s social history
- Referring to community support services
- Connecting patients with resources such as housing advocacy, women’s shelters, or food banks.
Digital tools can augment this work by:
- Flagging risk indicators in patient records
- Automating referrals to non-clinical services
- Integrating social and digital insights into care planning
This whole-person approach doesn’t just treat illness; it supports well-being.
For more insights into how social determinants shape clinical interventions, explore Dr. Chris Hobson’s white paper on The Importance of Social Determinants of Health in Determining the Right Clinical Interventions.
Digital vs. Social: A Shared Responsibility
While distinct, SDoH and DDoH are deeply interconnected. Communities most affected by poverty, housing instability, or low education are also more likely to face digital exclusion. A comprehensive approach to equity must tackle both realms simultaneously.
Addressing these determinants isn’t just the responsibility of healthcare providers. It requires cross-sector collaboration between governments, innovators, funders, public health authorities, and communities. Together, we can build a future where every person has a fair opportunity to live a healthy online and offline life.
Can social and digital Determinants of health be positive?
Absolutely. While often framed as barriers, both social and digital determinants can enhance health when addressed effectively:
- Positive SDoH, including stable employment, safe housing, strong social networks, and access to education, all promote mental and physical well-being.
- Positive DDoH, including affordable internet, user-friendly apps, and high digital literacy, can increase self-management of chronic conditions, support telehealth adoption, and improve medication adherence.
By creating environments that foster these positive determinants, we shift the focus from illness to wellness.
Are Social Determinants of health modifiable?
Yes. We have the power to modify and improve social determinants, thereby reducing their negative impact on patients and the population’s health. System-level actions, such as policy reform, community investment, and health system innovation, can enhance access to housing, education, healthcare, and digital infrastructure.
At an individual level, people can strengthen their health outcomes by:
- Building strong social connections to improve mental well-being and reduce isolation
- Improving digital literacy to access online health services and manage their care.
- Pursuing education and skills development
- Making healthy lifestyle choices when environments and resources make these options accessible
Although individuals can take these and other essential steps, broader support from clinicians, communities, governments, and technology partners is vital in creating environments where everyone can thrive both offline and online.
Social determinants of health vs health disparities
While they are related, they are not the same:
- Social Determinants of Health are non-traditional medical factors that have a significant influence on health outcomes.
- Health Disparities are inequities in those outcomes, such as shorter life expectancy or higher disease rates among marginalised populations.
SDoH often drives health disparities. By addressing the root causes, such as income inequality, we can begin to eliminate unjust differences in health outcomes.
Social and Digital Determinants of Health are not peripheral; they are foundational. As healthcare leaders, clinicians, and innovators, it is time to cease treating them as externalities and begin integrating them into the core of how we design and deliver care.
At Orion Health, we create solutions that empower systems to achieve this, unifying data, revealing hidden needs, and facilitating proactive, person-centred interventions. Improving health outcomes begins with understanding what truly drives them. Want to learn more?
Authored by Dr. Chris Hobson, Global Chief Medical Officer at Orion Health
References:
- https://www.who.int/health-topics/social-determinants-of-health. Retrieved May 21 2025, from WHO website
- World report on social determinants of health equity: executive summary. Geneva: World Health Organization; 2025. https://doi.org/10.2471/B09387. Licence: CC BY-NC-SA 3.0 IGO.
- World Health Organization. GHE: Life expectancy and healthy life expectancy [website]. 2024 (https://www.who.int/data/ gho/data/themes/mortality-and-globalhealth-estimates/ghe-life-expectancyand-healthy-life-expectancy, accessed 2 May 2024).
