By Carli Friedman, CQL Director of Research
Social determinants of health are conditions, environments, and settings that impact not only health but also overall quality of life. Social determinants of health recognize that many factors can contribute to health beyond just health and safety. By examining social determinants of health we are better able to create social and physical environments that promote the health of everyone – it is necessary for health equity.
The aim of this study conducted by CQL | The Council on Quality and Leadership was to examine disparities in social determinants of health outcomes among people with disabilities. To do so, we analyzed Personal Outcome Measures® data from approximately 1,500 people with disabilities using the Social Determinants of Health Index.
We found a number of differences in how many social determinants of health related outcomes people had present depending on their demographics (see figure below). Controlling for all other variables, women (8.3%) had fewer social determinants of health outcomes present than men (10.8%). People of ‘other’ races (1.2%) had fewer outcomes present than White people (10.8%). People with personality/psychotic disabilities (5.7%) had fewer outcomes present than those without those disabilities (10.8%). In addition, people with physical disabilities (4.9%) had fewer outcomes present than those without this disability (10.8%). Those people who lived in intermediate care facilities for people with developmental disabilities (ICFDD; 3.3%) had fewer outcomes present than those who lived in their own homes (10.8%).
Social Determinants of Health Outcomes Present by Demographics
There were additional disparities when we looked at the three individual factors of the Social Determinants of Health Index (see full study for more information). In terms of choice and engagement outcomes, Black people, people with physical disabilities, people who lived in provider owned- or operated-homes, people who lived in ICFDD, and people who lived in ‘other’ settings all had fewer outcomes present. In terms of person-centeredness outcomes, people from ‘other’ races, people with personality/psychotic disabilities, people with seizure disorders or neurological disabilities, and people with ‘other’ disabilities had fewer outcomes present. In terms of health and safety outcomes, people who primarily communicated through ‘other’ means had fewer outcomes present than those who primarily communicated through verbal/spoken language.
Despite these disparities, our analyses also found that organizational supports can significantly increase the social determinants of health outcomes of people with disabilities, regardless of their demographics (see figure below). For example, people with disabilities who had 2 out of a possible 21 organizational supports in place had 18.6% of social determinants of health outcomes present. In contrast, people with disabilities who had 12 out of the possible 21 organizational supports in place had 57.6% of social determinants of health outcomes present.
The Impact of Organizational Supports on Social Determinants of Health Outcomes
“Addressing the many health disparities people with disabilities face will require a multipronged approach that addresses robust service delivery problems, directing attention to issues that trickle down (e.g., unpaid care labor, direct support staff wages, etc.), and the many forms of prejudice and discrimination that impact not only the ways people are treated but also decision-making about government priorities. Much work is necessary but unearthing the disparities that exist is one of the first steps in attending to them” (Friedman, 2021, p. 14).
Disparities in Social Determinants of Health Outcomes