Dr. Sandro Galea

“One of the biggest challenges that this country has in terms of understanding health is understanding that health is much more than medicine. We tend to think of health literacy as understanding my doctor’s prescriptions, understanding what I may read about side effects. I think that’s an extraordinarily narrow conception of health literacy… Health is a product of medicine, but also a product of so many other traditionally non-medical factors.”

-Dr. Sandro Galea, Dean of the Boston University School of Public Health, for STAT, September 2017. Dr. Galea was the guest speaker at MAMH’s 2017 Annual Meeting of its Board of Directors.

Social Determinants of Mental Health

Social, economic and environmental factors that influence health are referred to as social determinants of health (SDOH). Examples of social determinants include economic stability, education, social and community context, access to health care and health literacy, and the built environment.

The importance of social determinants of health are recently recognized as important to overall health, including mental health. According to the World Health Organization:

Social inequalities are associated with increased risk of many mental health conditions. Taking action to improve the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages provides opportunities both to improve population mental health and to reduce the risk of those mental conditions that are associated with social inequalities… Scientific consensus is considerable that giving every child the best possible start will generate the greatest societal and mental health benefits.

While high quality, affordable health care is essential, nonmedical factors – including social, environmental and behavioral factors -- play a larger role in determining overall health and well being.

State & National Initiatives

Fortunately, state and federal health reform efforts are placing greater emphasis on social determinants of health, both to improve the health of patient populations and to reduce health care spending. The Health Policy Commission’s Accountable Care Organization (ACO) certification standards include requirements related to addressing social determinants of health. The MassHealth 1115 Demonstration similarly places significant focus on the integration of health-related social services. Likewise, the Centers for Medicare and Medicaid Services (CMS) developed a 10-question screening tool to identify patients’ social service needs; the tool can be used for treatment planning and referrals to community supports.


MAMH Perspective

The relationship between social determinants of health and mental health is well established. MAMH works with our partners to raise awareness about the importance of social determinants on near and longer-term health outcomes. We advocate for policies and programs to help individuals and families have access to the community resources and supports they need to live full, healthy lives. These include policies and programs to address poverty, education, employment and housing security. We work to further a fully integrated physical health care, behavioral health care, and social services system where the impact of social determinants on overall health is not only recognized, but fully addressed.