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3rd Edition: Social Determinants of Health
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3rd Edition: Social Determinants of Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 8436

Special Issue Editors

Prof. Dr. Roland J. Thorpe, Jr.

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Guest Editor
Program for Research on Men's Health, Johns Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Baltimore, MD 21205, USA
Interests: minority aging; stress and biopsychosocial pathways influencing age-related outcomes among black men over the life course; black–white disparities in age-related outcomes among men in middle to late life; social determinants of age-related outcomes among black and white men
Special Issues, Collections and Topics in MDPI journals
Dr. Paul Archibald

E-Mail Website
Guest Editor
1. College of Staten Island, City University of New York, Staten Island, NY 10314, USA
2. Johns Hopkins University Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, Baltimore, MD 21205, USA
Interests: public health social work clinical practice and training; prevention and treatment of mental and physical health outcomes among persons exposed to chronic stressors—especially those exposed to the criminal justice system; impact of social determinants of health on stress-related health disparities
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Marino A. Bruce

E-Mail Website
Guest Editor
1. UHPH Collaboratories, UH Population Health, University of Houston, Houston, TX 77204, USA
2. Department of Behavioral and Social Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX 77204, USA
Interests: social and behavioral science; minority aging; religiosity; spirituality; biopsychosocial pathways influencing physical and cognitive functioning among black males over the life course and across generations
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Some months ago, we organized the first and second editions of this Special Issue. These proved to be immensely engaging and attracted numerous authors, and we firmly believe that this topic merits further exploration through the release of a new Special Issue.

The endeavour to eliminate health disparities has led to modest progress in the past three decades. Over this period, research on health disparities has documented differences between groups; however, explanations for these observed disparities remain elusive. Data from this line of research suggest that health outcomes at the individual or population level are influenced by cultural, economic, political, and social factors that are classified as social determinants. Within the past decade, social determinants of health have been posited as a plausible explanation for most health disparities. Yet, there has been little focus on how social determinants of health impact health disparities or the health of minorities.

We invite investigators to contribute original research (empirical and theoretical) and systematic reviews that will further broaden our understanding of the cultural, economic, political, and social factors that contribute to, or may decrease, health disparities. Papers that include qualitative, quantitative, or mixed methods are welcome, as are papers that discuss the design, implementation, and evaluation of behavioral and policy interventions. An important aspect of every manuscript selected for inclusion in this Special Issue will be a focus on the social determinants of health disparities and/or the application of research findings associated with a reduction in health disparities. Potential topics include, but are not limited to, the following:

  • Papers that discuss, refine, or test theoretical models specifying the relationship between social determinants, the health of marginalized populations, and the presence of health disparities.
  • Papers that emphasize an intersectional approach (e.g., race, gender, and social class) in advancing our understanding of social determinants and health disparities.
  • Papers that highlight how social determinants have implications for individual- (e.g., discrimination), place- (e.g., urbanicity), and community-oriented (e.g., segregation) factors and their contribution to health disparities.
  • Descriptions of epidemiological studies explicitly examining social determinants and their association with the health of marginalized populations or health disparities.
  • Descriptions of intervention studies that consider how social determinants of health affect health among marginalized populations or reduce health disparities.

Prof. Dr. Roland J. Thorpe, Jr.
Dr. Paul Archibald
Prof. Dr. Marino A. Bruce
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • social determinants
  • health disparities
  • race, gender, and social inequalities
  • health equity, discrimination
  • urban and rural environment’ community factors

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Related Special Issues

Published Papers (10 papers)

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Research

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23 pages, 2794 KiB  
Article
Precarity in the Modes of Living: Proposing an Index for Studying Health Inequities at the Ecological Level in Colombia
by Hugo-Alejandro Santa Ramírez, Andrés-Felipe Ramírez-Giraldo, Hugo Pilkington, Carme Borrell and Gabriel-Jaime Otálvaro-Castro
Int. J. Environ. Res. Public Health 2025, 22(4), 537; https://doi.org/10.3390/ijerph22040537 - 1 Apr 2025
Viewed by 363
Abstract
Deprivation indices are used to monitor health inequities. However, their theoretical underpinnings have been based on the context of Western industrialized countries, which have distinct social and historical backgrounds compared to Latin America and the Caribbean and countries in the Global South. Following [...] Read more.
Deprivation indices are used to monitor health inequities. However, their theoretical underpinnings have been based on the context of Western industrialized countries, which have distinct social and historical backgrounds compared to Latin America and the Caribbean and countries in the Global South. Following the Latin American Social Determination of Health perspective, particularly the category Modes of Living supported by the construct of precarity, we aimed to develop an index of precarity in the modes of living at the department level in Colombia and assess its geographical distribution and potential value for public health. We conducted an ecological cross-sectional study with national administrative records. We developed a precarity index through Principal Component Analysis and performed spatial autocorrelation analyses and regression models with child mortality indicators. Our final index comprised twenty indicators representing four dimensions of the modes of living and power relations. We found precarity not to distribute randomly in Colombia, with a center-periphery divide and higher precarity observed in the country’s margin. We also found an association of our index with under-five mortality (SMR = 1.19; 95%CI 1.08–1.31) and infant mortality (SMR = 1.13; 95%CI 1.00–1.26). Our index highlights the relevance of considering the modes of living when devising deprivation indices or similar measures from Colombia or Latin America. This approach may provide different perspectives on the health-disease process and potential value for public health planning. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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20 pages, 670 KiB  
Article
Positive Childhood Experiences, Cognition, and Biomarkers of Alzheimer’s Disease
by Joshua H. Owens, Charles C. Windon, Dan Mungas, Rachel A. Whitmer, Paola Gilsanz, Jennifer J. Manly and M. Maria Glymour
Int. J. Environ. Res. Public Health 2025, 22(4), 525; https://doi.org/10.3390/ijerph22040525 - 30 Mar 2025
Viewed by 280
Abstract
Positive childhood experiences (PCEs) have unknown effects on late life cognition and Alzheimer’s Disease biomarkers. We examined 406 Asian, 1179 Black, 349 Latinx, and 498 White KHANDLE and STAR study participants with data on PCEs, longitudinal cognitive measures, MRI (n = 560), and [...] Read more.
Positive childhood experiences (PCEs) have unknown effects on late life cognition and Alzheimer’s Disease biomarkers. We examined 406 Asian, 1179 Black, 349 Latinx, and 498 White KHANDLE and STAR study participants with data on PCEs, longitudinal cognitive measures, MRI (n = 560), and amyloid PET (n = 281). We conducted mediation and multigroup models within the structural equation modeling framework allowing us to examine the direct association of PCEs with episodic memory level and change as well as the indirect effects of PCEs through education. We additionally conducted linear regressions examining the association of PCEs with MRI and amyloid PET outcomes. Average participant age was 74 (53–90) and 62% were female. Overall, PCEs were positively associated with memory intercept and change. Education significantly mediated the association between PCEs and memory intercept. PCEs were not associated with hippocampal volume or amyloid burden in the combined sample or across individual ethnocultural groups. PCEs are positively related to episodic memory through the promotion of educational attainment. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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10 pages, 253 KiB  
Article
Perceived Discrimination Is a Mediator of Rural Identity and Cardiometabolic Multimorbidity Among U.S. Adults
by LaToya J. O’Neal, Lisa Scarton, Ara Jo, Biswadeep Dhar, Folakemi T. Odedina and Diana J. Wilkie
Int. J. Environ. Res. Public Health 2025, 22(3), 426; https://doi.org/10.3390/ijerph22030426 - 14 Mar 2025
Viewed by 369
Abstract
The rise in prevalence of cardiometabolic multimorbidity indicates the need for more research examining associated risk factors. Identifying multilevel risk factors is especially critical for U.S. health disparity populations who have been shown to experience a disproportionate burden of chronic disease-related morbidity and [...] Read more.
The rise in prevalence of cardiometabolic multimorbidity indicates the need for more research examining associated risk factors. Identifying multilevel risk factors is especially critical for U.S. health disparity populations who have been shown to experience a disproportionate burden of chronic disease-related morbidity and mortality. This study examines differences in the prevalence of and risk factors associated with cardiometabolic multimorbidity status among health disparity populations in a representative sample of U.S. adults. Additionally, we investigate the role of perceived discrimination as a mediator of the relationship between rural identity and cardiometabolic multimorbidity status. We report the overall and stratified prevalence of cardiometabolic multimorbidity. Findings from multivariate logistic regression indicated that age, rural identity, healthcare access, and perceived discrimination were associated with higher odds of cardiometabolic multimorbidity. Perceived discrimination was found to be a significant mediator for the relationship between rural identity and cardiometabolic multimorbidity status. These findings have implications for the design and implementation of effective multilevel interventions to reduce the impact of perceived discrimination on cardiometabolic multimorbidity among rural adults. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
13 pages, 751 KiB  
Article
Perception of the Residential Living Environment: The Relationship Between Objective and Subjective Indicators of the Residential Living Environment and Health
by Joachim Gotink and Sylvie Gadeyne
Int. J. Environ. Res. Public Health 2025, 22(3), 391; https://doi.org/10.3390/ijerph22030391 - 7 Mar 2025
Viewed by 610
Abstract
Multiple studies have found an association between ambient air quality, noise pollution, green spaces and health. The underlying mechanisms of this association remain partly unknown. In this study, we focus on subjective perception as a potential underlying factor. We assess (I) the association [...] Read more.
Multiple studies have found an association between ambient air quality, noise pollution, green spaces and health. The underlying mechanisms of this association remain partly unknown. In this study, we focus on subjective perception as a potential underlying factor. We assess (I) the association between objective and subjective indicators of the living environment and all-cause mortality, as well as (II) the potential modification of the relationship between objective exposures and all-cause mortality by subjective perception: The data consisted of a linkage between the 2001 census, mortality register data from 1 October 2001 to 31 December 2016 and objective indicators of the residential living environment (air and noise pollution and green spaces). We used Cox regression to investigate the impact of objective and subjective indicators of the living environment and their potential interaction effect on all-cause mortality in the Brussels Capital Region: A negative subjective perception of the residential living environment is associated with an increased risk of mortality, even when controlling for socio-demographic parameters. Similarly, objective indicators of air pollutants and green spaces are also related to mortality. When studying the interaction effect, the beneficial effect of a neutral subjective perception stands out. Subjectively satisfied individuals living in the worst objective conditions showed the highest level of mortality hazard. Noise pollution was the only exception, characterized by the lack of an interaction effect: This study showed that besides objective indicators, the subjective perception of the residential environment also matters, and both interact to influence life chances. Subjective indicators not only have a genuine independent impact but also act as an underlying factor in the relationship between the objective residential environment and health. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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13 pages, 269 KiB  
Article
The Impact of City-Led Neighborhood Action on the Coproduction of Neighborhood Quality and Safety in Buffalo, NY
by Katharine Robb, Pablo Uribe, Eleanor Dickens, Ashley Marcoux, Jessica Creighton and Jorrit de Jong
Int. J. Environ. Res. Public Health 2025, 22(3), 341; https://doi.org/10.3390/ijerph22030341 - 26 Feb 2025
Viewed by 545
Abstract
Creating and sustaining safe, healthy urban environments requires active collaboration between residents and local governments. Public safety and the upkeep of public spaces depend, in a large part, on residents’ reports of crime and service needs. However, in underserved areas, factors such as [...] Read more.
Creating and sustaining safe, healthy urban environments requires active collaboration between residents and local governments. Public safety and the upkeep of public spaces depend, in a large part, on residents’ reports of crime and service needs. However, in underserved areas, factors such as urban decay, inadequate public services, and concentrated disadvantage have weakened these cooperative dynamics. This breakdown can exacerbate the underreporting of crime and service needs and deepen neighborhood inequalities. In Buffalo, NY, the city-led initiative “Clean Sweeps” works to reduce neighborhood disparities through rapid beautification and community outreach in targeted city blocks. The program aims to improve quality of life by reducing crime and blight while fostering greater community engagement. In an analysis of data from 77,955 matched properties (published elsewhere), we found that residents were more likely to report drug-related crimes (via 911) and blight-related service needs (via 311) compared to untreated properties in the 6 months following the Clean Sweep. In this study, we analyze data from 21 interviews with city staff and four focus groups with residents to explore how interventions in the social and physical environment of neighborhoods, like the Clean Sweep innovation, can influence residents’ willingness to coproduce with local government. We identify improved responsiveness, trust, and self-efficacy as key mechanisms impacting residents’ reporting behavior. The findings show how relatively simple environmental interventions paired with outreach can help create safer, healthier neighborhoods. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
14 pages, 723 KiB  
Article
Social Return on Investment (SROI) Evaluation of Citizens Advice on Prescription: A Whole-Systems Approach to Mitigating Poverty and Improving Wellbeing
by Rachel Granger, Ned Hartfiel, Victory Ezeofor, Katharine Abba, Rhiannon Corcoran, Rachel Anderson de Cuevas, Benjamin Barr, Aregawi Gebremedhin Gebremariam, Roberta Piroddi, Clare Mahoney, Mark Gabbay and Rhiannon Tudor Edwards
Int. J. Environ. Res. Public Health 2025, 22(2), 301; https://doi.org/10.3390/ijerph22020301 - 17 Feb 2025
Cited by 1 | Viewed by 933
Abstract
Citizens Advice on Prescription (CAP), a Liverpool (UK)-based service, provides welfare advice and link worker social prescription support to people experiencing and at risk of experiencing financial or social hardship. CAP, which receives referrals from healthcare and third-sector services, aims to improve service [...] Read more.
Citizens Advice on Prescription (CAP), a Liverpool (UK)-based service, provides welfare advice and link worker social prescription support to people experiencing and at risk of experiencing financial or social hardship. CAP, which receives referrals from healthcare and third-sector services, aims to improve service users’ financial security, health, and wellbeing. A mixed-methods social return on-investment (SROI) analysis was used to evaluate this service. Between May 2022 and November 2023, a subset of service users (n = 538) completed the Short Warwick–Edinburgh Mental Wellbeing Survey (SWEMWBS) at baseline and a 2-month follow-up. Supporting quantitative and qualitative economic data were also collected (February 2023–February 2024) through semi-structured interviews (n = 16). Changes in social value were determined by comparing pre- and post-SWEMWBS scores. These scores were then mapped to monetary values using the Mental Health Social Value Bank (MHSVB). SROI ratios were then calculated by dividing the change in social value by the associated service provision costs. The mean social value change per person ranged from GBP 505.70 to GBP 697.52, and the mean service provision cost was GBP 148.66 per person. The overall study reported a positive SROI return range of GBP 1: GBP 3.40–GBP 4.69. The results indicate that non-clinical support services, like CAP, may be an effective intervention for addressing the wider determinants of health and wellbeing. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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14 pages, 738 KiB  
Article
Examining Health Insurance and Non-Medical Challenges Among Vietnamese Americans in Texas During the COVID-19 Pandemic
by Alexander Le, Saba Siddiqi, Celine Nguyen, Ben King, Paul Gerardo Yeh, Jannette Diep, Lauren Gilbert and Bich-May Nguyen
Int. J. Environ. Res. Public Health 2025, 22(2), 189; https://doi.org/10.3390/ijerph22020189 - 29 Jan 2025
Viewed by 2276
Abstract
When COVID-19 data on Asian Americans are available, they are frequently aggregated, concealing community-specific concerns. Consequently, there is limited COVID-19 literature on Vietnamese Americans. In this study, we investigated the association between health insurance coverage and non-medical challenges during the COVID-19 pandemic, in [...] Read more.
When COVID-19 data on Asian Americans are available, they are frequently aggregated, concealing community-specific concerns. Consequently, there is limited COVID-19 literature on Vietnamese Americans. In this study, we investigated the association between health insurance coverage and non-medical challenges during the COVID-19 pandemic, in Vietnamese Americans in Texas. The NIH Community Engagement Alliance (CEAL) Common Survey 2 was administered electronically in English and Vietnamese and contained 23 questions about non-medical drivers of health, COVID-19 vaccination, and research participation. Vietnamese American adults in Texas were recruited between September 2021 and March 2022 via partnerships with community organizations. Responses were compared and analyzed using logistic regression. Of 217 respondents, 23 (11%) were uninsured. Of the uninsured participants, 43% lost health insurance coverage during the COVID-19 pandemic. Uninsured individuals had significantly higher odds of experiencing non-medical challenges, including obtaining housing (OR = 6.10, p < 0.001), food (OR = 6.41, p < 0.001), and medications (OR = 3.45, p < 0.05) than insured individuals. Uninsured individuals had a significantly longer time-lapse since seeing a healthcare provider (ordinal OR = 0.20, p < 0.05) than insured individuals. Thus, lack of insurance is strongly associated with non-medical challenges during the COVID-19 pandemic among Vietnamese Americans in Texas. Disaggregating data can address non-medical drivers of health, advancing equity for marginalized communities. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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Review

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11 pages, 884 KiB  
Review
Health Disparities at the Intersection of Racism, Social Determinants of Health, and Downstream Biological Pathways
by Roland J. Thorpe, Jr., Marino A. Bruce, Tanganyika Wilder, Harlan P. Jones, Courtney Thomas Tobin and Keith C. Norris
Int. J. Environ. Res. Public Health 2025, 22(5), 703; https://doi.org/10.3390/ijerph22050703 (registering DOI) - 29 Apr 2025
Abstract
Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many [...] Read more.
Despite overall improvements in the accessibility, quality, and outcomes of care in the U.S. health care system over the last 30 years, a large proportion of marginalized racial and ethnic minority (minoritized) groups continue to suffer from worse outcomes across most domains. Many of these health disparities are driven by inequities in access to and the scope of society’s health-affirming structural resources and opportunities commonly referred to as structural drivers or social determinants of health—SDoH. Persistently health-undermining factors in the social environment and the downstream effects of these inequities on neurocognitive and biological pathways exacerbate these disparities. The consequences of these circumstances manifest as behavioral, neurohormonal, immune, and inflammatory and oxidative stress responses, as well as epigenetic changes. We propose a theoretical model of the interdependent characteristics of inequities in the SDoH driven by race-based discriminatory laws, policies, and practices that eventually culminate in poor health outcomes. This model provides a framework for developing and validating multi-level interventions designed to target root causes, thereby lessening health disparities and accelerating improved health outcomes for minoritized groups. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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22 pages, 1224 KiB  
Review
What Is Social Connection in the Context of Human Need: An Interdisciplinary Literature Review
by Kyla L. Bauer, Rachel Johnson-Koenke and Meredith P. Fort
Int. J. Environ. Res. Public Health 2025, 22(3), 363; https://doi.org/10.3390/ijerph22030363 - 1 Mar 2025
Viewed by 1168
Abstract
The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America’s loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures [...] Read more.
The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America’s loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures during the COVID-19 pandemic, there is a global urgency to better understand social connection in public health responses. However, meaningfully effective interventions for social isolation or loneliness have yet to be identified, and the consensus that social connection is an equivalent human need is unclear. To understand what social connection, oxygen, water, food, and shelter have in common regarding population health, we conducted an interdisciplinary literature review between September 2021 and October 2024, seeking to find commonalities between research literature advocating social connection as a human need critical to survival and key concepts across population health disciplines that explain how oxygen, water, food, and shelter function as human needs. We integrated the concepts of evolution, resource, environment, ecosystem, exposure science, embodiment, homeostasis, allostatic load theory, and interdisciplinary from 44 core publications to develop a unified conceptual model and definition for social connection as a human need. We believe a holistic understanding of social connection within the shared context of oxygen, water, food, and shelter can better support health researchers across a variety of disciplines to find common ground in developing evidence-based interventions within public health. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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Other

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25 pages, 1113 KiB  
Systematic Review
Determinants of Access to Sexual and Reproductive Health for Adolescent Girls in Vulnerable Situations in Latin America
by Fabian Dávila, Favio Cala-Vitery and Luz-Tatiana Gómez
Int. J. Environ. Res. Public Health 2025, 22(2), 248; https://doi.org/10.3390/ijerph22020248 - 10 Feb 2025
Cited by 1 | Viewed by 1198
Abstract
Latin American upper-middle-income countries (LAUMICs) face significant challenges in ensuring equitable access to sexual and reproductive health (SRH) for adolescents due to socioeconomic inequalities, migration, and historical violence. This systematic review examines the barriers and facilitators to sexual and reproductive health access for [...] Read more.
Latin American upper-middle-income countries (LAUMICs) face significant challenges in ensuring equitable access to sexual and reproductive health (SRH) for adolescents due to socioeconomic inequalities, migration, and historical violence. This systematic review examines the barriers and facilitators to sexual and reproductive health access for adolescent girls (≤19 years old) in vulnerable situations across Latin America. Using six databases, 391 articles were reviewed; 10 met the inclusion criteria, and 10 more were included through backward search, resulting in 20 analyzed studies. Structural barriers such as economic, regulatory, and institutional constraints were found to restrict SRH access, exacerbated by social stigma and negative narratives, especially in cases involving sexual violence and clandestine abortions. Facilitators included intersectoral collaboration, preventive education, and community networks, which improved access to and the quality of services for vulnerable populations. The findings emphasize the need for sustainable strategies that address structural inequalities and stigma while strengthening health systems, and intersectoral cooperation. Comprehensive, culturally tailored education and clear regulatory frameworks are essential to achieving equitable and sustainable SRH services. These insights offer practical guidance for public policy and program design in LAUMICs, particularly for addressing the needs of marginalized adolescent populations. Full article
(This article belongs to the Special Issue 3rd Edition: Social Determinants of Health)
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