Social Determinants of Health

The Health Determinant Portfolio

Understanding the complex factors affecting child health is important for you as a pediatrician.  The Health Determinant Portfolio is a tool you can use throughout your Community Pediatrics and Advocacy Rotation.

The Health Determinant Portfolio is a web-based conceptual model that highlights the complex interaction that occurs with different factors at the individual, home, neighborhood, city, county, state, and national level.  This model was developed based on the socio-ecological model and several key academic articles. 3,4,5,67,8,9,10,11,1213,14,15,16

  • This model allows you to:
    • Explore the social determinants of health  
    • Learn about specific child health outcomes and health disparities 
    • Access resources for patients 
    • Integrate your experiences throughout the Community Pediatrics and Child Advocacy Rotation 
    • Reflect on your learning experience


How to use the model 

The model below prompts you to think about different domains (Individual, Home, Neighborhood, City, County, State, National & Beyond) and how factors in each domain might affect a child's health. In addition, you can click on several sample health outcomes (Childhood Obesity, Asthma, Anemia, and Oral Health) that link you to data, policy statements, and resources organized by domain.

Click on the links below to learn more.



  2. Murray CJL, Kulkarni SC, Michaud C, Tomijima N, Bulzacchelli MT, et al. (2006) Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States. PLoS Med 3(9): e260.
  3. Northridge ME, Sclar ED, Biswas P. (2003) Sorting out the Connections Between the Built Environment and Health: A Conceptual Framework for Navigating Pathways and Planning Healthy Cities. Journal of Urban Health 80 (4):556
  4. Schulz A, Northridge ME. (2004) Social Determinants of Health: Implications for Environmental Health Promotion. Health Educ Behav 31 (4):455
  5. Adler NE, Newman K. (2002) Socioeconomic Disparities in Health: Pathways and Policies: Inequality in education, income, and occupation exacerbates the gaps between the health “haves” and “have-nots.” Health Affairs 21 (2):60
  6. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. (2004) Actual Causes of Death in the United States, 2000. Jama 291 (10):1238
  7. Syme SL. (2008) Reducing Racial and Social Class Inequalities in Health: The Need for a New Approach: Is it possible for the majority of Americans to see that inequality is a corrosive issue that is damaging all of us? Health Affairs 27(2):456
  8. Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE. (2003) The Community Guide’s Model for Linking the Social Environment to Health. Am J Prev Med 24(3s):12
  9. Wilensky GR, Satcher D. (2009) Don’t Forget about the Social Determinants of Health. Health Affairs 28(2):w194
  10. Parry J, Judge K. (2005) Tackling the Wider Determinants of Health Disparities in England: A model for Evaluating the New Deal for Communities Regeneration Initiative. Am J Public Health 95(4):626
  11. Wilcox LS. (2007) Onions and Bubbles: Models of the Social Determinants of Health.Prev Chronic Dis 4(4):1
  12. Shonkoff JP, Boyce WT, MeEwen BS. (2009) Neuroscience, Molieccular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention. Jama 301 (21):2252
  13. Social Determinants of Health: the solid facts. 2nd edition/ World Health Organization Report 2003, edited by Richard Wilkinson and Michael Marmot
  14. Marmot M. (2003) Understanding Social Inequalities in Health. Perspectives in Biology and Medicine 46(3):S9
  15. Krieger N. (2008) Ladders, pyramids and champagne: the iconography of health inequities. J Epidemiol Community Health 62: 1098
  16. Gelhert S, Sohmer D, Sacks T, Mininger C, McClintock M, Olopade O. (2008) Targeting Health Disparities: A Model Linking Upstream Determinants to Downstream Interventions: Knowing about the interaction of societal factors and disease can enable targeted interventions to reduce health disparities. Health Affairs 27(2):339