Creating healthier populations: an assessment of the use of data on social determinants of health to inform decision-making in eight countries

BACKGROUND: This work serves as a cases study for the findings of the Rockefeller Foundation-Boston University Commission on Health Determinants, Data, and Decision-Making (3-D Commission). The dissertation assessed public views of what matters for health, the degree of incorporation of SDoH in Covid-19 decision-making, and the mental health consequences of SDoH disruptions in diverse contexts using multiple data sources. METHODS: An online survey collected relevant individual-level data from Brazil, China, Germany, Egypt, India, Indonesia, Nigeria, and the United States using RIWI—a professional global survey platform that uses a patented Random Domain Intercept Technology™ (RDIT™). National-level data retrieved included Covid-19 policy data from the Oxford Covid-19 Government Response Tracker (OxCGRT) and data from the International Labour Organization (ILO) on the informal labor sector. All data were used in descriptive and multivariable regression analyses. RESULTS: Of 8,754 respondents, 56.2% (95% CI: 55.1%, 57.2%) ranked healthcare as the most important determinant of health. Politics was the determinant with the greatest absolute difference between what respondents considered matters for health versus what they perceived decision-makers think matters for health. Overall, more restrictive Covid-19 stay-at-home orders were associated with a higher burden of SDoH disruptions while more expansive income support policies were associated with a lower burden of disruptions. The lowest two income quintile in all countries reported the highest burden of employment insecurity, financial insecurity, and food/supplies insecurity. The income gradient of SDoH disruptions persisted after controlling for government income support policies. Experiencing Covid-19 SDoH disruptions was then associated with a higher burden of both depression symptoms and probable post-traumatic stress disorder (PTSD). The prevalence of probable PTSD was about three times higher among people who experienced at least one Covid-19 SDoH disruption compared to those who did not experience a disruption. CONCLUSION: This research showcases the need for more investment in communication efforts around the importance of SDoH both to the general public and decision-makers. Moreover, SDoH disruptions and their association with adverse mental health outcomes during the Covid-19 pandemic highlight the lack of consideration for SDoH in the design and implementation of policies. Countries in different contexts would benefit from implementing the 3-D Commission principles and recommendations to ensure that decision-making on health is guided by equity and informed by data on SDoH.

Author dc:creator

• Abdalla, Salma M.

Advisor dc:contributor.advisor

• Galea, Sandro

• Public health
• Employment
• Food security
• Global health
• Mental health
• Public policy
• Social determinants of health

Statement dc:rights

• Attribution-NonCommercial-NoDerivatives 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nc-nd/4.0/

Language dc:language.iso

en_US

Handle dc:identifier.uri

https://hdl.handle.net/2144/45078

OAI identifier oai:identifier

oai:open.bu.edu:2144/45078