SDOH Glossary
Explicit Bias: The person is very clear about his or her feelings and attitudes, and related behaviors are conducted with intent. This type of bias is processed neurologically at a conscious level as declarative, semantic memory, and in words. Conscious bias in its extreme is characterized by overt negative behavior that can be expressed through physical and verbal harassment or through more subtle means such as exclusion. An example of explicit bias is someone placing a “No Gays Allowed” sign on their storefront and refusing services for members of the LGBTQ&+ community.
Implicit Bias:– Implicit or unconscious bias operates outside of the person’s awareness and can be in direct contradiction to a person’s espoused beliefs and values. What is so dangerous about implicit bias is that it automatically seeps into a person’s affect or behavior and is outside of the full awareness of that person. Implicit bias can interfere with clinical assessment, decision-making, and provider-patient relationships such that the health goals that the provider and patient are seeking are compromised. An example of implicit bias is that often overweight people are labeled as lazy, weak, and lacking self-control. Healthcare professionals may blame serious health issues on weight, therefore, unintentionally ignoring other possible causes.
National Center for Cultural Competence: https://nccc.georgetown.edu/bias/module-3/1.php
Cultural Competency: The integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices and attitudes used in appropriate cultural settings to increase the quality of services with the intention of producing better outcomes.
Cultural Humility: Life-long process of self-reflection and self-critique whereby the individual not only learns another’s culture, but one starts with an examination of his/her own beliefs and cultural identities.
Diversity: Describes the myriad ways in which people differ, including the psychological, physical andsocial differences that occur among all individuals, such as race, ethnicity, nationality,socioeconomic status, education, age, gender, gender identity or expression, sexual orientation,martial status, mental and physical ability and learning styles.
Environmental Justice: The fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income, with respect to the development, implementation, and enforcement of environmental laws, regulations and policies. This goal will be achieved when everyone enjoys:
-The same degree of protection from environmental and health hazards, and
-Equal access to the decision-making process to have a healthy environment in which to live, learn, and work.
Equality: The condition under which every individual is treated in the same way, and is granted the same rights and responsibilities, regardless of their individual differences.https://equity.aha.org/glossary
Equity: ‘The attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities’ (Healthy People 2030).Care that meets the patients where they are at, regardless of location, socioeconomic status, gender, and many other characteristics and social drivers.
Equity vs. Equality: Equity represents impartiality, the distribution is made in such a way to even opportunities for all the people. Conversely, equality indicates uniformity, where everything is evenly distributed among people. https://equity.aha.org/glossary
Health equity: That everyone has a fair and just opportunity to achieve optimal health. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.
Food Security: “Food security (is) a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” (Food and Agriculture Organization of the United Nations. Trade Reforms and Food Security: Conceptualizing the Linkages. Food and Agriculture Organization of the United Nations; Rome, Italy: 2003. p. 313.)
Food Sovereignty: The right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems. It puts the aspirations and needs of those who produce, distribute and consume food at the heart of food systems and policies rather than the demands of markets and corporations.
http://usfoodsovereigntyalliance.org/what-is-food-sovereignty/
Health disparities: Healthy People 2030 defines a health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.” One of the overarching goals of Healthy People 2030: “Eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all.”
U.S. Health and Human Services: https://health.gov/healthypeople/priority-areas/health-equity-healthy-people-2030National
Inclusivity: The practice or policy of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalized, such as those having physical or intellectual disabilities or belonging to other minority groups. An inclusive environment and inclusive care is when diversity is leveraged to create a fair, healthy and high-performing organization or community. It also enables individuals and groups to feel safe, respected, engaged, motivated, and valued for who they are and for their contributions toward organizational and societal goals.
Intergenerational Trauma: The concept developed to help explain years of generational challenges within families. The transmission (or sending down to younger generations) of the oppressive or traumatic effects of a historical event. As generational cycles occur, negative patterns and traits are known to transfer through multiple generations via learned behavior, family dynamics and environment. Historical examples of groups affected by generational trauma include Black Americans, Holocaust survivors, and Indigenous communities, among others. In Montana, we are especially aware of the intergenerational and unconscious grief experienced by Indigenous peoples passed from generation to generation due to forced relocation, land dispossession, and loss of spiritual practices, language and culture.
Institutional Racism: Refers specifically to the ways in which institutional policies and practices create different outcomes for different racial groups. The institutional policies may never mention any racial group, but their effect is to create advantages for whites and oppression and disadvantage for people from groups classified as people of color.
https://equity.aha.org/glossary
Structural Racism: Normalization and legitimization of an array of dynamics – historical, cultural,institutional and interpersonal – that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color. It is a complex system by which racism is developed, maintained and protected.
https://equity.aha.org/glossary
Social Determinants of Health: Non-medical factors that influence outcomes. Conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. By addressing the underlying issues that prevent people from being healthy, we are working towards health equity.
The SDOH are typically grouped into five domains: economic stability, Education access and quality, health care access and quality, neighborhood and built environment and social and community context.
Structural Barriers: Obstacles that collectively affect a group disproportionately and perpetuate or maintain stark disparities in outcomes. Structural barriers can be policies, practices, and other norms that favor an advantaged group while systematically disadvantaging a marginalized group.
Upstream/Downstream Interventions: We often discuss health using the metaphor of a stream, with upstream factors bringing downstream effects. Social needs interventions create a middle stream. It is not a choice, of one over the other. We need social and economic interventions at both the community and individual level.
Upstream efforts seek to create community-level impact and improve community conditions by addressing social determinants of health through policy, laws, and regulations. Upstream interventions help to decrease barriers and improve supports that allow people to achieve their full health potential.
Midstream efforts seek to create individual-level impact by meeting individuals’ social needs through screenings, referrals, and other individually-focused processes/protocols. They are further upstream than medical interventions, but not yet far enough. Social workers, community health workers, and/or community-based organizations provide direct support/assistance to meet patients’ social needs.
Downstream efforts seek to create patient-level impact by providing clinical care. Redefining the meaning of “social determinants” to be mostly or only about the immediate social needs of expensive patients makes it harder to focus on the systemic changes necessary to address root causes of poor health.
Improvements in our nation’s health can be achieved only when we have the commitment to move even further upstream to change the community conditions that make people sick. The demand for social needs interventions won’t stop until the true root causes are addressed.
https://www.movinghealthcareupstream.org/examples-in-action-2/