Social determinants of health are broad and often defined in the context of other factors that also impact health. For example, the Institute of Medicine's (IOM) report, Capturing Social and Behavioral Domains and Measures in Electronic Health Records, defined social determinants as “sociocultural, socio-economic, and socio-demographic status; biosocial interactions; and the various levels of social context…” This IOM report differentiated social from behavioral factors in that the latter indicate observable actions, underlying cognitions, and/or other related psychological constructs. Similarly, Tarlov's framework posited “social and societal characteristics” as one of 5 major categories of determinants of population health, with the others being genes and biology, health behaviors, medical care, and the “ecology of all living things.” Although exact definitions vary somewhat, there is consensus that social determinants include many distinct concepts, and taken as a whole, they substantially influence health outcomes and contribute to health disparities.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
  • ABBREVIATIONS TABLE
• INTRODUCTION
• METHODS
  • DEVELOPMENT OF CONCEPTUAL AND ANALYTIC FRAMEWORKS
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • KEY QUESTIONS 1 AND 2. How do Veterans compare to non-Veterans in prevalence and characteristics of social determinants of health? Does variation in social determinants of health account for differences in health services access, health behaviors, and health outcomes between Veterans and non-Veterans?
  • KEY QUESTIONS 3 AND 4. How do engaged (ie, enrolled in or utilizing categories of VHA services or benefits) Veterans compare to non-engaged (ie, not enrolled in or utilizing VHA services or benefits) Veterans in prevalence and characteristics of social determinants of health? Does variation in social determinants of health account for differences in health services access, health-related behaviors, and health outcomes between engaged Veterans and non-engaged Veterans?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE FOR KEY QUESTIONS 1 AND 2
  • SUMMARY OF EVIDENCE FOR KEY QUESTIONS 3 AND 4
  • LIMITATIONS
  • APPLICABILITY AND IMPLICATIONS FOR POLICY AND PRACTICE
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX C. EVIDENCE TABLES

Suggested citation:

Duan-Porter W, Martinson BC, Taylor B, Falde S, Gnan K, Greer N, MacDonald R, McKenzie L, Rosebush C, Wilt TJ. Evidence Review: Social Determinants of Health for Veterans. VA ESP Project #09-009; 2017.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Minneapolis VA Health Care System, Minneapolis, MN, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.