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Social Drivers of Health

Social determinants of health (SDOHs), according to the World Health Organization, are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

Healthy People 2020 organizes SDOH into 5 key domains:

  • economic stability (eg, poverty and food insufficiency)
  • education (eg, high school graduate and early childhood education)
  • social and community context (eg, concerns about immigration status and social support)
  • health and health care (eg, health insurance status and access toa health care provider)
  • neighborhood and built environment(eg, neighborhood crime and quality of housing)

The AAP recommends surveillance for risk factors related to social determinants of health during all patient encounters. Practices can use a written screener or verbally ask family members questions about basic needs such as food, housing, and heat. Find resources here.

Positive and Adverse Childhood Experiences

Research shows many health and well-being disparities are rooted in early childhood. Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes.

Safe, stable, nurturing relationships and supportive community and health care environments protect against childhood stressors such as adverse childhood experiences and their prolong exposure called toxic stress. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories.

Pediatricians play a pivotal role in a comprehensive well-child care in intervening to promote, identify, and treat safe, stable, and nurturing relationships for lifelong health. Find resources on the public health approach to early relational health.

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American Academy of Pediatrics