By Jointra Editorial Team, Certified EMT
The medical care system — including EMS — is responsible for only an estimated 10–20% of health outcomes. The rest is shaped by social, economic, and environmental factors that precede clinical encounters. These are the social determinants of health (SDOH).
Understanding SDOH doesn't change what an EMT or paramedic does on a call. But it changes how they interpret what they see — and it explains why some communities and populations generate far more EMS calls than others.
The World Health Organization and Healthy People 2030 organize SDOH into five domains:
1. Economic Stability Poverty, employment, food security, housing stability. People who cannot afford medications miss doses. People experiencing food insecurity develop worse diabetes outcomes. People in unstable housing have higher rates of hypothermia, infectious disease, and injury.
2. Education Access and Quality Health literacy — the ability to obtain, process, and understand health information — is directly tied to educational attainment. Low health literacy is associated with worse chronic disease management, more emergency department use, and higher mortality.
3. Healthcare Access and Quality Geographic access, insurance coverage, and continuity of care. The uninsured and underinsured use EMS and emergency departments as primary care — not by choice, but by necessity.
4. Neighborhood and Built Environment Walkability, proximity to healthy food, air and water quality, exposure to violence. "Food deserts" — areas without access to fresh, affordable food — are associated with higher rates of obesity, diabetes, and cardiovascular disease. Environmental exposures (lead, air pollution, industrial contamination) cause long-term health harm.
5. Social and Community Context Social isolation, discrimination, community cohesion, incarceration rates. Social isolation is associated with outcomes comparable to smoking 15 cigarettes per day.
Every shift provides evidence of SDOH in action:
Individual clinical encounters can integrate SDOH screening (food security, housing stability, transportation access) to connect patients with social services. At the systems level, addressing SDOH requires policy: living wage laws, affordable housing, equitable school funding, environmental justice regulation, and expanded healthcare access. These are not EMS responsibilities — but understanding them is essential for anyone who wants to understand why the patients they serve are sick in the first place.