For many people, thoughts turn to home during the holidays – to nourishment of body and soul, an appreciation that where we come from makes us who we are. Researchers in the UAB Minority Health & Health Equity Research Center Social Determinants of Health Core (SDH Core) focus on that connection year-round, looking at how the places we call home and the systems that shape our lives profoundly affect our health.

The World Health Organization (WHO) defines the social determinants of health as the nonmedical factors that influence health – housing, transportation, education, work life, access to quality health care – and the forces and systems that shape daily life. Multiple studies have found that social determinants of health account for 30% to 55% of our health outcomes. The SDH Core helps researchers across UAB and beyond incorporate social determinants into their studies and understand how these factors affect population health or can be modified to improve health.

“Gabriela Oates, Ph.D.Where we live isn’t random,” says SDH Core director Gabriela Oates, Ph.D. “It depends on the educational, economic, and life opportunities we’re afforded, which are shaped by policies that start well upstream – what we refer to as societal structure. And then, the conditions in which we live affect our health through a number of biological and behavioral mechanisms – stress, for example – that interact with our physiology.” In short, where we live affects our choices and opportunities, which in turn can trigger disease or affect disease progression.

An excellent example of SDH-grounded research is that of Qasim Hussaini, M.D., M.S., an assistant professor of medicine in the Division of Hematology and Oncology and a health systems researcher at the O’Neal Comprehensive Cancer Center. Hussaini and his colleagues won pilot project funding from the UAB Cancer Awareness, Research, Engagement, and Support (CARES) Center in 2024 to examine the impact of public policy on colon cancer outcomes.

In the 1930s, the federally sponsored Home Owners’ Loan Corporation factored race Qasim Hussaini, M.D., M.S.into its risk assessment of home loans. Neighborhoods with large proportions of Black residents were mapped in red – thus the term “redlining” – and were flagged as poor risks for mortgage financing. This led to neighborhood disinvestment – withholding public and private funding, services, or other resources – and created unhealthy living environments that persist to the present.

“We looked at historical redlining policy from the 1930s and at colon cancer outcomes today,” Hussaini explains. “We chose colon cancer because it’s a leading cause of cancer deaths but also a disease that’s very much treatable if you catch it early.”

The research team found that residents of historically redlined neighborhoods had poor access to health care in general and cancer treatment in particular. For example, they were less likely to receive a colectomy, a surgical procedure to remove part or all of the colon. They further found that even if the patient received the surgery, it was less likely to be guideline concordant. Patients from redlined neighborhoods were also less likely to receive chemotherapy.

The SDH Core is dedicated to advancing research on the impacts of the social determinants of health, working with investigators as they consider how the circumstances in which people are born, live, work, and age affect one’s health. It provides services and consultation to any investigator who wants to include social determinants of health in their work.

Ritu Aneja, Ph.D.,“Let me tell you, it’s amazing work they do,” says Ritu Aneja, Ph.D., associate dean for research and innovation in the School of Health Professions, of the SDH Core team. “I cannot praise it enough. I feel like what Gabriela Oates and [co-director] Liz Baker have done is phenomenal."

Aneja emphasizes the significance of the SDH Core being in the South, a region with long-entrenched racial disparities in chronic conditions, including cancer, diabetes, and obesity.

She notes the team’s “deep knowledge of epidemiology, sociology, statistics, demography – all these disciplines. It is really quite unique.”

The SDH Core has assisted Aneja with two grants examining breast cancer outcome disparities between African American and white women. “The rich insights we’ve gained working with them, and how we have applied them to our projects,” she says, “have really elevated those projects.”

Among the SDH Core’s primary objectives going forward, Oates stresses, is developing training programs on how to measure social determinants and conduct research with such measures. “It’s important not only to keep providing services but to build a critical mass of trained investigators with understanding of the complexities of this work.”

Live HealthSmart Alabama (LHSA), the inaugural winner of the UAB Grand Challenge and an initiative of the MHERC, is exploring ways to address social determinants and make good health easier to achieve. The idea is that by changing structural factors like policies, systems, and the built environment, LHSA can make it easier for people to adopt healthy lifestyles. LHSA has worked with community partners, businesses, and local governments to improve parks and sidewalks, enhance the tree canopy, install lighting, and repair/install sidewalks to make being physically active more accessible. LHSA has also implemented a mobile market offering fresh produce and other pantry staple items in communities that do not have a grocery store, and a mobile wellness van that provides free health screenings and links people to primary care if needed. These proof-of-concept initiatives can provide a foundation for larger-scale changes in the food distribution and medical care systems to promote healthy eating and prevention and wellness.

Oates acknowledges that improving health and reducing health disparities requires foundational commitment at every level.

“People often say, ‘Our health system or our program is addressing the social determinants of health.’ But tackling these societal issues requires more than what one organization or program can do alone. It requires economic, policy, and systems changes in all sectors of life.”

That’s food for thought while we’re home for the holidays.