Beyond the Exam Room: Why Social Determinants of Health Shape Every Clinical Conversation
✨ Too Long Didn’t Read (TL;DR) / Summary
Social Determinants of Health (SDoH)—like housing, education, food access, work conditions, and social connection—shape up to 40% of health outcomes, far outweighing clinical care alone.
Chronic stress from adverse social conditions disrupts immune, cardiovascular, neurologic, and mental health systems—often across generations.
Cardiovascular disease, cancer, neurologic disorders, musculoskeletal pain, and early brain development are all deeply influenced by SDoH.
Providers don’t need perfect screening tools to start—just curiosity, empathy, and conversation.
When clinicians intentionally build trust, listen deeply, and acknowledge context, outcomes improve—even when treatment plans stay the same.
🧾 Self-Compassion: General Information
What Are Social Determinants of Health?
The World Health Organization defines social determinants of health as non-medical factors that influence health outcomes—the conditions in which people are born, grow, work, live, and age, plus the systems shaping daily life.
Research consistently shows:
Clinical care explains ~20% of modifiable health outcomes
Social determinants explain ~40%
**Public health measures account for the remaining ~40%**
In short: what happens outside the clinic often matters more than what happens inside it.
Have you ever stubbed your toe?
Two different scenarios , same event - stubbing your toe.
Scenario 1: You’re having a wonderful day, you got to exercise, you just had lunch, it’s payday, you’ve got dinner plans with friends later, and then… you stub your toe. How do you react?
Most often, this hurts for a few seconds, you may hop on one foot for a bit, then go about your day without thinking about it again
Scenario 2: You’re having an awful day, you haven’t exercised in weeks, you’re extremely hungry, you lost your job and are still looking for a new one, you just moved to a new city where you have no friends or family yet and then… you stub your toe. How do you react?
This may end up being the most painful injury you’ve had in a long time. It stings, throbs, and aches for days afterwards. You’re miserable and can’t get over the pain to the point where you’re wondering if you need to see a doctor.
Same event - completely different responses. Why might this be?
Stress: The Common Thread
Living with unstable housing, food insecurity, unsafe neighborhoods, discrimination, or social isolation creates constant physiologic stress. Over time, this stress:
Dysregulates cortisol (your “stress hormone”)
Alters neurologic development
Triggers inflammatory and epigenetic changes
Increases morbidity and mortality
These effects can even be passed across generations, meaning today’s social environments shape tomorrow’s health outcomes.
How SDoH Show Up Clinically
Keep in mind, SDoH do not cause these conditions ; however, they can be significantly related to the development of the following conditions:
❤️ Cardiovascular Disease & Hypertension
Some research has shown metabolic risk factors influenced by SDoH to account for greater than 40% of cardiovascular events
Some data even suggests that low education alone may be a significant contributor to over 1 in 10 cardiovascular deaths
Hypertension disparities persist globally and within the U.S., disproportionately affecting marginalized populations
🎗️ Cancer
SDoH are linked to later diagnoses, lower screening rates, more aggressive disease, and poorer survival across colon, breast, lung, and prostate cancers
🧠 Neurologic Conditions
Stroke, epilepsy, dementia, multiple sclerosis, headache disorders, and ALS all demonstrate disparities driven by structural and social factors
🦴 Musculoskeletal Pain & Physical Therapy Outcomes
A significant portion of physical therapy outcomes are driven by contextual and nonspecific effects, including therapeutic alliance, expectations, and social context—not just the intervention itself
👶 Early Brain Development
Prenatal SDoH influence fetal and neonatal brain structure, function, and long-term neurodevelopment, reinforcing the importance of early intervention
👩⚕️ For Providers 👨⚕️
Why Conversation Is Clinical Care
Most major medical organizations endorse SDoH screening, yet no single tool captures the full picture.
What does work consistently?
👉 Relationship-centered care
👉 Empathetic listening
👉 Curiosity without judgment
Even when resources are limited, being seen and heard changes outcomes.
Questions Providers Can Ask Patients
You don’t need a checklist—start with connection:
“What does a typical day look like for you?”
“Do you feel like you have a lot of stress in your life? If so, what causes that?”
“Are there things outside of the issue we’re working on that make it hard to follow this plan?”
“Do you feel safe where you live and work?”
“Who do you rely on when things feel overwhelming?”
“Have stress, finances, or access to food or transportation been affecting your health lately?”
“How are you doing today?" , “Are you OK?” , “How does that affect you?”
These questions:
Normalize struggle
Build trust
Reveal barriers early
Strengthen therapeutic alliance
Where Providers Can Make a Difference
Education
Early childhood and social–emotional education lowers risky behaviors, improves lifelong health, and reduces cardiovascular risk decades later.Providers can educate their patients within their scope of practice as well as provide additional resources.
Food Security
Food insecurity—affecting ~10% of U.S. households—is linked to diabetes, hypertension, depression, poor sleep, and increased health care utilization.Providers can supply resources like nutrition.gov to help locate local food sources and assistance programs
Built Environment
Housing quality, pollution exposure, green space access, and neighborhood safety directly influence chronic disease risk.Providers can educate patients on programs like The U.S. Department of Housing and Urban Development’s (HUD) Find Shelter tool to find temporary housing, food pantries, medical clinics, and more.
Social Connection
Loneliness can carry a mortality risk comparable to smoking ½ pack of cigarettes per day. Improving social connection improves mental, behavioral, and physical health across the lifespan.Providers can provide comfort and connection, simply by taking the time to listen and genuinely care for the patient
🌱 Closing Thoughts: Care That Sees the Whole Person
At the heart of social determinants of health is a simple but powerful truth: health does not begin or end in the exam room. It lives in kitchens and classrooms, neighborhoods and workplaces, relationships and lived experiences. When clinicians take the time to ask, listen, and understand these contexts, care becomes more than a treatment plan—it becomes a partnership.
Addressing these social determinants of health doesn’t mean providers must fix every social challenge a patient faces. It means recognizing what patients carry with them, validating their experiences, and working together to find realistic, compassionate paths forward. Sometimes the most therapeutic intervention is being heard without judgment. Sometimes it’s naming a barrier out loud. And sometimes it’s simply letting a patient know they’re not navigating it alone.
At The Joint Connection Company, we believe that connection is clinical. When providers lead with curiosity, empathy, and respect, they don’t just improve outcomes—they restore trust in healthcare itself. And that may be one of the most powerful determinants of health we have.
📂 Supplemental Information / Citations
Morelli V. Social determinants of health: an overview for the primary care provider. Prim Care. 2023;50(4):507-525. doi:10.1016/j.pop.2023.04.004
Chaturvedi A, Zhu A, Gadela NV, Prabhakaran D, Jafar TH. Social determinants of health and disparities in hypertension and cardiovascular diseases. Hypertension. 2024;81(3):387-399. doi:10.1161/HYPERTENSIONAHA.123.21354
Rosendale N. Social determinants of health in neurology. Neurol Clin. 2022;40(1):231-247. doi:10.1016/j.ncl.2021.08.012
Braaten AD, Hanebuth C, McPherson H, et al. Social determinants of health are associated with physical therapy use: a systematic review. Br J Sports Med. 2021;55(22):1293-1300. doi:10.1136/bjsports-2020-103475
Anaya B, Triplett R, Rogers CE, Smyser CD. Social determinants of health and early brain development. Pediatr Clin North Am. 2025;72(5):975-990. doi:10.1016/j.pcl.2025.05.013
This content drafted, researched, edited, and generated by:
McKinley Pollock, PT, DPT
McKinley Pollock, PT, DPT, OCS, CSCS is a physical therapist with a background in orthopedics and sports rehabilitation. Dr. Pollock earned his doctorate of physical therapy from Campbell University in 2021, is a board-certified orthopedic clinical specialist (OCS), and certified strength and conditioning specialist (CSCS). Dr. Pollock enjoys combining lessons learned from his DPT training and research, translating these into clinical practice. His passions include promoting relationships between patients & clinicians to promote clinical effectiveness, satisfaction, and efficiency, the implementation of primary preventative medicine into clinical practice, and leadership and education development.
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