Understanding social determinants of health in dietetics

According to the World Health Organization, social determinants of health reflect, “the conditions in which people are born, grow, live, work and age.” Social determinants of health are the components of a person’s life that impact their ability to achieve and maintain their physical, emotional, and psychological health.¹ Dietitians need to be mindful of a client’s background to provide optimal, personalized nutrition care. 

Social determinants of health domains 

According to the USDA, social determinants of health can be grouped into five domains: 

1. Economic stability 
2. Education access and quality 
3. Healthcare access and quality 
4. Neighborhood and built environment 
5. Social/community context 

Impact on food choice 

Factors such as income level, job security, and housing can all play a major role in stress level, sleep quality, and food security. As we know, each of these factors can directly influence hunger and satiety regulation, stress hormones, and food choice. Research shows that individuals who have experienced periods of food scarcity are more likely to make impulsive food choices, prioritizing instant gratification and palatability. Food insecurity has been linked to increased food anxiety, intake of convenience foods, risk of chronic illness, and impaired growth and development.² 

Housing and education can both play a large role in the ability to prepare meals at home. Barriers such as unstable housing, lack of cooking appliances, and/or a food preparation knowledge deficit may contribute to a decreased ability to cook for oneself. As dietitians, we should be cognizant of these factors in attempting to meet clients where they are.  

How can we consider social determinants of health in our practice? 

As dietitians we are uniquely qualified to identify resource scarcity, social systems, and food insecurity by asking our patients or clients the right questions. Knowing more information about our patients and clients helps us to provide more individualized care. Rather than asking just about food type and quantity, we could delve deeper by asking questions like: 

• Do you usually eat with family or friends or by yourself? 
• Who prepares the meals in your household? 
• How often do you cook meals at home? 
• Where do you buy groceries? 
• Do you ever worry about not having enough food to eat? 
• What cooking appliances and utensils do you have? 

Be an advocate in your practice! Whether you work in private practice, inpatient, or long-term care, dietitians are uniquely qualified to connect patients or clients to resources and education that can help alleviate the burdens of social, economic, or environmental instability.  

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References 

Hahn RA. What is a social determinant of health? Back to basics. J Public Health Res. 2021;10(4):2324. Published 2021 Jun 23.  

Savary S, Waddington S, Akter S, et al. Revisiting food security in 2021: an overview of the past year. Food Secur. 2022;14(1):1-7.