Surveillance and screening for social determinants of health: The medical home and beyond

Social determinants—the circumstances in which people live and work—powerfully affect health. In fact, social and environmental factors are estimated to have twice the impact of quality health care on the overall health of an individual. Research in such diverse fields as epidemiology, neuroscience, genomics, and molecular and developmental biology is advancing our understanding of how social risk factors, manifesting as toxic stress, get “under the skin” of vulnerable children via epigenetic changes and disruptions to key physiological and neurocognitive pathways. For example, the Adverse Childhood Experiences Study demonstrated strong associations between childhood maltreatment and later-life health and well-being. Hertzman described the profound, long-term influence of the “biological embedding of early experience.” Mitigating the effect of harmful social determinants is critical for promoting the optimal health and development of children throughout their life span. Surveillance and screening for social determinants and ensuring families’ linkage to community-based programs and services deserve consideration as a strategy to promote children’s optimal health and development in the 21st century.