UCLA

Among the various factors that shape health, people’s circumstances, and the environments they live in hold profound influence. Areas with poor quality or overcrowded housing, few options for nutritious food, limited space for physical activity, and high levels of pollution are often areas deprived of monetary resources. These broader factors, termed the social determinants of health (SDoH), impact health and well-being across the life course. Addressing these factors has become part of the purview of the healthcare system efforts, amid a growing recognition that illness and poor health outcomes frequently stem from disparities and inequities rooted in social determinants, such as poverty, education, housing, access to nutritious food, and social support networks. Increasingly, healthcare systems are investing in initiatives to collect data on various social risk factors affecting health outcomes. However, the extent to which this data is used todevelop more holistic interventions that address multiple simultaneous social risk factors that influence individual health outcomes is limited. Moreover, current approaches do not leverage existing data regarding the community context to better understand the lifelong implications of social risk, which may begin in early childhood and persist into adulthood, affecting both social circumstances and individuals’ interactions with the healthcare system. Furthermore, while the healthcare system plays a crucial role in ensuring access to care, the extent to which broader social determinants can limit access remains an area of ongoing work. The three studies in this dissertation use data on social risk factors to better understand the broader set of these social determinants and their associations with health outcomes. These studies reveal patterns at both the individual and community levels, highlighting how social risk tends to cluster and how early life experiences influence where people live in adulthood for those with a history of childhood adversity. These findings emphasize the need for approaches that combine health care system efforts with community-based initiatives to better address health-related social needs throughout the life-course.