Understanding Social Determinants of Health: A Guide for Medical School Interviews

Why Social Determinants of Health Matter

Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age. They include factors such as income, education, housing, employment, social support, and access to healthcare. These factors often have a greater impact on health outcomes than clinical care alone.

Medical schools emphasise SDOH because understanding them is essential for delivering equitable, holistic care. Doctors who recognise these factors can identify barriers to health, advocate for patients, and design interventions that address root causes rather than just symptoms. Interviewers ask about SDOH to test whether you can think beyond the biomedical model, appreciating the social, economic, and environmental context of patients’ lives. Demonstrating this awareness shows that you are ready to approach patient care comprehensively and empathetically.

How to Approach SDOH Questions in Interviews

When answering questions about social determinants, a structured approach works best: set the context → provide a specific example → reflect → show insight or action. This mirrors the method used for personal insight questions and ensures clarity and depth in your response.

Case Study: Mr. X

Mr. X is a 62-year-old man who presents to A&E with shortness of breath and general fatigue. He has a known history of type 2 diabetes and hypertension. On admission, his blood glucose readings are consistently elevated, and he appears dehydrated.

He lives alone in a small rented flat in an urban area. Recently, he lost his job as a delivery driver due to company downsizing, leaving him struggling financially. He sometimes cannot afford groceries and often relies on cheap processed foods. Mr. X does not have a car and depends on infrequent public transport to attend medical appointments, which has caused him to miss his last two outpatient visits.

Socially, Mr. X is isolated. His family lives abroad, and he reports minimal contact with friends or neighbours. He also expresses anxiety about his finances and difficulty paying bills. He has limited understanding of his diabetes medications, often forgetting doses or adjusting them himself.

Clinically, Mr. X is overweight, appears malnourished in parts, and has a mild foot ulcer that has been slow to heal. His blood pressure is mildly elevated, and his overall management of diabetes appears poor.

Task for Students:
Identify the social determinants of health that may be contributing to Mr. X’s poorly controlled diabetes and other health issues. Consider his living situation, financial circumstances, social support, health literacy, access to healthcare, and psychosocial stressors.

Model Answer

Mr. X’s poorly controlled diabetes can be explained by multiple social determinants of health. Financial insecurity is a major factor; having recently lost his job, he struggles to afford nutritious food and relies on cheap, processed meals that worsen blood glucose control. Living alone and social isolation mean he lacks support to remember medications, attend appointments, or manage daily self-care. Health literacy is another factor, as he does not fully understand his diabetes medications and often adjusts doses himself, leading to inconsistent control. Access to healthcare is limited because he depends on infrequent public transport, which caused him to miss clinic visits and follow-ups. Finally, psychosocial stress from financial pressure and isolation likely contributes to poor adherence and overall health deterioration. Together, these determinants interact to explain why his diabetes is poorly managed, highlighting the importance of a holistic, patient-centered approach that addresses both medical and social needs.

Why This Works

This structured approach demonstrates empathy, awareness, and critical thinking. Interviewers can see that you can:

• Identify multiple social determinants affecting a patient’s health

• Understand their impact on outcomes

• Think about practical solutions to support the patient

Medical schools want candidates who consider the whole patient, not just the illness, and who respond thoughtfully and resourcefully to complex social challenges.

Common SDOH Interview Questions

• “How do social factors affect a patient’s health?”

• “Give an example of how poverty or education impacts health outcomes.”

• “What would you do if a patient’s social situation prevented them from following medical advice?”

Use the structured approach: context → example → reflection → action. Always link your response back to the skills and mindset required for a future doctor: empathy, advocacy, problem-solving, and critical thinking.

Key Takeaways

1. Know what SDOH are – income, education, housing, employment, social support, environment, and access to healthcare.

2. Understand why they matter – they often influence health outcomes more than clinical care alone.

3. Be ready to reflect – discuss how social factors affect patients and what you have observed or learned.

4. Show insight or action – through volunteering, work experience, or thoughtful reasoning about future clinical practice.

Medical schools want candidates who can see the whole patient and address social challenges thoughtfully and compassionately.