Social Determinants of Health for CEMS

Social Determinants of Health: A Core Priority for Community Paramedicine

Key Takeaways:

Social Determinants of Health (SDOH) are non-medical factors that profoundly influence health outcomes.
These include income, housing, education, employment, transportation, food access, and social support.
Community paramedics are uniquely positioned to identify and intervene on SDOH during home visits.
Addressing SDOH improves health equity, reduces 911 reliance, and enhances chronic disease management.
Effective MIH/Community EMS programs require strong community partnerships and knowledge of local resources.

Introduction

In the world of Mobile Integrated Healthcare (MIH) and Community Paramedicine, there’s growing recognition that health isn’t created in hospitals—it’s shaped by daily life. That’s where Social Determinants of Health (SDOH) come in. These are the conditions in which people live, work, learn, and interact, and they can mean the difference between wellness and chronic illness.

Community paramedics don’t just respond to emergencies; they see patients in the context of their homes and lives. That gives them a front-row seat to the barriers patients face—like empty refrigerators, lack of heat, unsafe housing, or no way to get to a doctor. This article outlines what SDOH are, how they affect health, and why paramedics need to understand and act on them to provide meaningful care.

What Are Social Determinants of Health?

The World Health Organization defines SDOH as “the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces shaping the conditions of daily life.” (WHO, 2023).

According to Healthy People 2030, SDOH fall into five key domains:

Economic Stability – Employment, income, expenses, debt, and financial stress.
Education Access and Quality – Literacy, early childhood education, vocational training.
Healthcare Access and Quality – Insurance coverage, provider availability, cultural competence.
Neighborhood and Built Environment – Housing, transportation, safety, parks, food access.
Social and Community Context – Discrimination, social cohesion, community engagement.

These factors often interact. A patient might not manage their diabetes well—not due to negligence, but because they can’t afford healthy food, missed a follow-up due to lack of transportation, and don’t understand their discharge instructions.

Why SDOH Matter in Community Paramedicine

1. SDOH Drive Health Outcomes More Than Clinical Care

Research shows that clinical care accounts for only about 20% of health outcomes, while social and environmental factors account for up to 50% (Hood et al., 2016). That means if we ignore SDOH, we’re only addressing a small piece of the puzzle.

2. Community Paramedics Are in a Prime Position to Intervene

Traditional EMS sees patients during acute events.
Community paramedics see what’s in the fridge, who’s helping mom take her meds, or how often a patient skips meals.
This visibility enables real-time assessment and referral to food banks, shelters, transport programs, and more.

3. Addressing SDOH Reduces ED Use and Readmissions

Programs that connect patients to housing assistance, transportation, or case management have shown reductions in:

911 call volume
Repeat ED visits
Hospital readmissions (especially for CHF, COPD, and diabetes)

Practical Examples for MIH Providers

Economic Instability

Scenario: A frequent 911 caller with poorly controlled asthma lives in a home with no heat.
Action: Paramedic refers the patient to utility assistance and social services.

Food Insecurity

Scenario: A diabetic patient has high glucose readings despite medication.
Action: Community paramedic finds no food in the house and coordinates with a food pantry.

Lack of Transportation

Scenario: A patient missed several primary care appointments post-discharge.
Action: Provider arranges medical transportation and follows up with the clinic.

How to Assess SDOH in the Field

Observation: Look for signs—empty cabinets, unsafe stairs, no heating or cooling.
Ask Open Questions:
- “Do you have any trouble getting your prescriptions?”
- “Are there times when you don’t have enough food?”
Use Screening Tools: Instruments like PRAPARE, AHC HRSN, or locally developed checklists.
Document & Refer: Integrate findings into reports and hand off to case managers or social workers.

Collaborating for Impact

Effective SDOH interventions require partnerships:

Public health departments
Food banks and housing coalitions
Faith-based organizations
Transportation services
Nonprofits providing wraparound services

Community EMS agencies should build resource guides, assign liaisons, and participate in local health improvement coalitions.

Conclusion

For community paramedics, SDOH isn’t just a buzzword—it’s the reality behind most of the calls we respond to. Understanding and addressing social determinants transforms care from reactive to proactive, and from temporary to lasting. It also aligns community paramedicine with the broader mission of health equity and whole-person care.

As healthcare systems shift to value-based models, EMS programs that can demonstrate improvements in social risk factors will be best positioned to lead. SDOH should be a standard part of every community EMS encounter—not an afterthought.

References

Centers for Disease Control and Prevention. (2024). Social Determinants of Health. https://www.cdc.gov/about/sdoh/index.html

Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016). County Health Rankings: Relationships between determinant factors and health outcomes. American Journal of Preventive Medicine, 50(2), 129–135. https://doi.org/10.1016/j.amepre.2015.08.024

Healthy People 2030. (2023). Social Determinants of Health. https://health.gov/healthypeople/priority-areas/social-determinants-health

World Health Organization. (2023). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health

Ready to Learn More?

Stay tuned for the next article in our Determinants of Health Series: “Health Behaviors: Supporting Patients Beyond the Emergency.“ 🚑