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February 23, 2022

Social Determinants of Mental Health: Recommendations for Research, Training, Practice, and Policy

Author Affiliations
  • 1Department of Psychiatry, University of California, San Diego, San Diego
  • 2Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, San Diego
  • 3Department of Psychiatry, Weill-Cornell Medical College, New York, New York
JAMA Psychiatry. 2022;79(4):283-284. doi:10.1001/jamapsychiatry.2021.4385

The notion that social factors have a major effect on human health goes back to ancient Greece. However, the first formal document about social determinants of health (SDoHs) with a global impact was not published until 1998.1 It defined SDoHs as conditions in the environments where people are born, live, learn, work, play, worship, and age that affect health, functioning, and quality-of-life outcomes. It listed several SDoHs: early childhood development; education, job opportunities, and income; racial and ethnic and other forms of discrimination; housing, transportation, and neighborhoods; and access to clean air and water and to quality affordable health care. The recent COVID-19 pandemic has exposed a critical need to refocus on SDoHs as health care disparities have worsened in populations where racism is endemic.

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Funding for Social determinants vs Technology; Out of Balance
Charles Dean, M.D. | Minneapolis VA Medical Center
Jested and Pender1 make a compelling case for more emphasis on the social determinants of mental health, pointing to the early onset of serious mental illnesses (SMIs) and substance use disorders (SUDs), and the long-term consequences, including a shorter life span. They also point to a serious crisis in mental health generally, with a decrease in longevity and a growing increase in health care inequities. Their case is reinforced by the special communication from Sterling and Platt2 on the rise in deaths of despair in the United States as compared with other industrialized nations. In both papers, the authors urge substantial improvements in our social support systems, education, clinical practice, and research.
Yet, as I have documented elsewhere3 our response to the rise in social inequality and health care inequities has been to emphasize and fund massive projects in genetics and technologies, projects accompanied by very high expenditures. A few examples: the Human Brain Initiative ($4.5 billion), the Precision Medicine Initiative ($1.4 billion), the Cancer Moonshot ($1.8 billion), and similar projects both here and internationally.4 Can we afford another, no doubt costly, initiative?
Charles E. Dean, M.D.
Staff without compensation
Minneapolis VA Medical Center
Minneapolis MN 55417.
cdean2465@gmail.com
Home address: 13420 Gull Ct: Apple Valley MN, 55124.
1. Jeste DV, Pender VB. Social determinants of mental health. Recommendations for research, training, practice, and policy. JAMA Psych 2022;79(4):283-284. Doi:10.1001/jamapsychiatry.2021.4385.
2. Sterling P, Platt ML. Why deaths of despair are increasing in the US and not in other industrial nations―insights from neuroscience and anthropology. JAMA Psych, published online February 2, 2022, E1-E7.
3. Dean, CE. Social inequality, scientific inequality, and the future of mental illness. Philos Ethics Humanit Med. (2017) 12:10. https://dx.doi.org/10.1186/s13010-017-0052-x.
4. Huang ZJ, Luo L. It takes the world to understand the brain. Science 2015;350:42-44.
CONFLICT OF INTEREST: None Reported
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