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What are social determinants of health? 

Social determinants of health (SDOH) refer to all of the environmental factors that affect wellness. Where children live, attend daycare or school, play with their peers, and participate in extracurricular activities all affect their overall wellness. 


Why do pediatric SDOH matter?

Many SDOH factors affect how easily children can access health care.  For example, research shows that about 1 in 10 people in the United States lacks health insurance. Without that coverage, children are less likely to go to primary care appointments, receive dental care or get needed medications. 

Other SDOH that can affect children’s health or their ability to receive health services may include: 

  • Challenging education environment 
  • Difficulty accessing nutritious food 
  • Economic instability 
  • Experiencing discrimination, racism or violence 
  • Literacy and language skill limitations
  • Polluted water or air 
  • Poor housing or homelessness

Preventing Adverse Childhood Experiences

Father helps his young daughter who holds a basketball on a basketball court

Research has also shown that adverse childhood experiences  (ACE) can affect children’s health and their long-term well-being. ACEs include all potentially traumatic events that occur during childhood. For example, children may: 

  • Endure abuse, neglect or violence  

  • Have a caregiver with substance use or mental health problems 

  • Witness violence in their home or in their community  

Preventing ACEs   can significantly improve children’s well-being. With such interventions, the show that we could potentially prevent:

  • Up to 1.9 million heart disease diagnoses

  • As many as 21 million depression diagnoses

Data on Health Disparities

At Nemours Children’s Health, we understand that learning about families’ lived experiences (PDF) is crucial for improving our systems and policies. We conduct research to better understand real-life needs — not just among families who come to our clinics but also across our communities and across the nation.

In 2019, we partnered with The Harris Poll to conduct a national survey of more than 1,000 parents of children under 18. We found key statistics such as: 

  • 32% said they’ve missed at least one of their child’s medical appointments in the last year because they were unable to get to it or pay for it.

  • 30% said they don’t have time to worry about their child’s health unless it’s a medical emergency. 

  • 23% worried they’d run out of food before getting money to buy more. 

Medical care accounts for only about 15% of a family’s overall well-being. We want to redefine health and health care so that we can better meet the needs of children and their families. Find out more about our survey (PDF) and redefining health for the well-being of children. 

Leadership in Children’s Health

Our leaders at Nemours are thought leaders in transforming children’s health care. Our president and CEO, Dr. Larry Moss, advances the national dialogue by engaging with other children’s health care leaders and the business community. 

Learn More
R. Lawrence Moss, MD, President and CEO of Nemours standing in front of quote by Alfred I. duPont

Racism and Health Disparities

Racism, discrimination and violence have always been social determinants of health that can profoundly impact children. During the COVID-19 pandemic, the racial health disparities that always existed in the United States only widened. 

Addressing these disparities requires a wider view — we can accomplish more by looking at what happens outside our hospitals. Read more about how children’s hospitals hold the keys to creating an America Without Limits (PDF).


Children’s SDOH and Informed Health Care 

Understanding the SDOH that affect our communities informs how we deliver health care. We are taking action to improve population health by:  

  • Advocating for federal and state policies that improve the health of all children 

  • Developing new screening tools that assess families for nonmedical health factors  

  • Establishing programs that assess for and educate families on adverse childhood experiences

  • Leading and learning with communities across the country to design population health networks that improve health and wellbeing outcomes for all residents 

  • Linking families with existing community resources 

  • Partnering with community-based organizations to prevent child illness, improve health and lower health care costs