Operationalizing the social determinants of health concept at the Colorado Department of Public Health and Environment

Background Academics and national organizations recommend incorporation of the social determinants of health (SDoH) into prevention planning as a method to improve health equity; however, specific steps on how to operationalize this concept are not provided.

Methods One state public health agency developed and integrated a SDoH conceptual framework into all prevention planning. Using this framework, a set of evidence-based data indicators was developed by an interdisciplinary workgroup including epidemiologists, program managers, and leadership. For each indicator, counties within the bottom quartile were identified. Counties with four or more indicators in the bottom quartile were deemed counties in need. To determine the relationship between the chosen SDoH indicators and increased health risk for adverse outcomes, the identified counties of need were matched with counties identified from the 2010 Robert Wood Johnson (RWJ) County Health Rankings health factors list.

Results Twelve data indicators from three main areas (economic, community, and social) were chosen to inform prevention programs at the state and county level. Of the 64 counties, 19 were identified with four or more indicators in the bottom quartile. The bottom 19 counties from the RWJ County Health Rankings health factors list were overlapped with the 19 identified counties of need. Sixteen of 19 counties matched.

Conclusion The development of state and county level social determinant of health data indicators by one state prevention services division was important for operationalizing the concept of social determinants of health and informing prevention programs.