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Social Determinants: Why They Matter and How Hazel Addresses Them

Comprehensive health care addresses more than just physical or mental concerns, but also the social and environmental context surrounding a person's health and well-being.
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Researchers have found that medical care accounts for only 20% of a person’s health outcomes. As much as 80% of health factors are influenced by social determinants, the conditions in which people are born, learn, live, work, play, worship and age. Where people live, work, go to school, and socialize, as well as the conditions of these environments, all play a major role in predicting health outcomes. Many social determinants are factors that an individual can not control, such as pollution, neighborhood violence, community green space, or healthy food availability.

At Hazel, addressing social determinants of health is a key component of our mission. Hazel was founded on the belief that the best health care addresses more than just physical or mental concerns, but also the social and environmental context surrounding a person's health and well-being.

Social determinants are grouped into 5 areas:

  1. Education access and quality - the link between a person’s access to quality education and their health, such as: school quality, access to tutors and guidance counselors, school safety
  2. Health care access and quality - the link between a person’s access to quality health care and their health, such as: medical coverage/insurance, access to preventive and acute medical care, health literacy
  3. Economic stability - the link between a person's financial situation and their health outcomes, such as: poverty, income, employment, housing stability, food security
  4. Neighborhood and built environment - the link between the environment a person lives or works in, and their health, such as: neighborhood safety, crime and violence, pollution (water, air, noise), transportation, parks, nutritious food, physical activity opportunities 
  5. Social and community context - the link between a person’s relationships, social context, and their health, such as: incarceration, discrimination, workplace conditions, and having access to supportive relationships

In order to deliver proactive care that helps improve health outcomes, health care providers should be aware of the social determinants impacting those they care for. They must consider how the social determinants influence how a person engages with their health, as well as their health outcomes. For example, if a person does not have access to a grocery store with healthy foods, they may face more challenges to maintaining a nutritious diet, increasing their risk of facing health conditions like heart disease, diabetes, and obesity. Someone who does not have access to transportation may be less able to access health care services, which can result in lower health literacy or missed diagnoses. 

Addressing Social Determinants

At Hazel, we understand that addressing social determinants can help ensure access to high quality care and improve patient health. We believe that for children across the country to experience improved health outcomes, we must consider the conditions in which they live and learn, and we must take steps to address challenges in their environment that contribute to poor health outcomes.

Let’s dive a bit deeper into each determinant, and examine broadly how each should be considered, and specifically, how Hazel addresses each social determinant.

Determinant 1: Access to Quality Education

There is a strong association between health outcomes and an individual’s education level. Individuals who have access to education throughout life are more likely to be and remain healthy. Across all racial and ethnic groups, adults with lower education attainment are more likely to report worse health outcomes. Children who have access to quality education throughout their development have better health outcomes, and are more likely to experience upward mobility. Later in life, these children are more likely to access quality, consistent health care, find employment that pays a decent wage, and live in a safe, clean environment. 

Programs that help children do well (and stay) in school, and programs that help families pay for colleges or learning support, are examples of ways to help address this social determinant. Investing in education can equate to investing in health, and vice versa.

How Hazel Helps

After a Hazel in-school visit, 90% of students are able to return to class, as opposed to being sent home. This saves 3 hours of instructional time on average, helping to reduce chronic absenteeism and thereby maximizing learning and classroom time. Understanding that health literacy is essential for good health, Hazel also shares health resources and tips with students and families. 

Determinant 2: Improving Access to Quality Health Care

In the United States, 28 million people are living without health insurance. Many people without health insurance lack access to a primary care provider (PCP). These individuals often do not have the financial means to make vital purchases for health, such as medications, diagnostic screenings, and often, surgery and other treatments.

Many people live far away from a hospital or clinic, and/or do not have the means to travel to these facilities. Others struggle with health literacy and access to accurate information concerning their health.

Interventions that increase access to health care providers and improve communication can help people get the care they need. Transportation assistance, neighborhood health screenings, telehealth services, reduction in emergency department wait times and insurance coverage education, are examples of programs that can help improve access to quality health care.

Remote solutions, such as telehealth, are an excellent way to bridge the barrier of access as they can remove what can often be an insurmountable challenge of transportation — enabling people to receive care who otherwise likely would not be able to (or would struggle to do so). Telehealth increases convenience, resulting in fewer work days missed for parents/guardians, and less missed class for kids.

How Hazel Helps

Hazel’s goal is to improve access to physical and mental health care. By bringing healthcare services directly into the school and home setting via video visits, children are able to access care where and when they need it. Hazel connects students with a medical provider (doctors, physician associates, nurse practitioners, and therapists) whether they are at home or at school, enabling the student to receive the care they need, where they are. After a Hazel visit, Hazel’s team of Family Resource Managers helps the patient and family get connected with the long term care they need within their community.

Hazel is available to all children, and regardless of insurance status. This ensures all children in have equal access to the care they need. 

Determinant  3: Economic Stability

Economic stability is a key predictor of good health. Today, around 37 million people in the United States live in poverty and more than 16% of children under 18 years old live below the poverty line. Many people can’t afford healthy foods, health care and housing.

Families with steady employment and a livable wage are more likely to be healthy. However, many people have trouble finding and keeping a job, and others don’t earn enough to afford the things they need to achieve good health. 

Employment programs, career counseling, high quality (low cost) childcare and housing assistance are examples of programs that help to foster economic stability. 

How Hazel Helps

Hazel serves all students, regardless of their financial or insurance status. This means that all children, those who have insurance, and those who don’t, can benefit from the service. 

Hazel helps students remain in school, and parents at work (parents don’t have to take off work to take their child to the doctor, resulting in missed pay in many cases). Hazel’s Family Resource Managers help connect families to community resources such as food services and housing programs. 

Determinant 4: Social and Community Context

Many social determinants are factors that an individual cannot control, for example unsafe neighborhoods, discrimination, or the capacity to pay for basic necessities. 

Programs that help people get needed social and community support (including access to health care providers who speak their language and with whom they can connect culturally) are critical for improving health. Examples include mentorship programs, support to families with an incarcerated family member, bullying prevention programs, and language translation services. 

How Hazel Helps

At Hazel, over 50% of providers identify as persons of color (PoC), and 40% of Hazel providers are bilingual, speaking more than 8 languages. Hazel providers reflect the communities they serve and are able to identify with the backgrounds and circumstances of their patients, and their patients' families and communities. 

Determinant 5: Neighborhood and Built Environment 

The neighborhood a person lives in has a major impact on their health. Factors like high rates of violence, unsafe water, low air quality,  noise pollution, and heavy traffic can introduce risks to a person’s health and safety.

At the community, state, and national level changes can be made to improve public environments and overall health. For example, bike and pedestrian lanes, community gardens, and trash pick-up initiatives are all examples of programs that improve living conditions and increase safety, resulting in healthier communities. 

How Hazel Helps

Hazel eliminates the barrier of travel by providing care where the child is—at school or at home, in a safe, culturally competent setting. Additionally, Hazel therapy services help students navigate the social and emotional challenges they may be dealing with at home, school, or in their communities, taking into account conditions such as asthma and allergies. 

Social Determinants Profoundly Impact Health

At Hazel, addressing the social determinants means:

  • Providing culturally competent health care services (diverse, multilingual providers that reflect the communities we serve)
  • Promoting health education and literacy 
  • Meeting students where they are (at school or at home) with telehealth
  • Building relationships between families and community resources and services
  • Working in partnership with the school, community, family, and student

Healthy people enjoy a combination of physical, mental, and social well-being — three factors of health that all influence one another. Where a person is born, lives, goes to school, and works influences the opportunities that person has to achieve good health. A healthy future and a healthy environment go hand-in-hand.

Healthy students. Healthy schools.

See how Hazel Health can keep your students healthy and ready to learn
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Hazel gets students the right support quickly
During the pandemic, a high school student was having a hard time coping. He was sad about COVID-19 impacting his senior year, and he was worried about the state of the world. The student was also struggling with some personal conflicts, and he felt he didn't have the right support at home.

After discussing his feelings, a Hazel doctor connected him with resources that he described as “life-changing.” He was very grateful and shared that he didn't know where to go for help before Hazel.
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Hazel expands Health Services at school
A child came into the health center with a sprained wrist. The school nurse helped her ice the injury, but she was still in pain. A Hazel doctor helped the nurse put the student’s wrist in a splint and gave her over-the-counter medicine to help relieve the pain.

The school nurse expressed how grateful she was that Hazel could help her care for the child. She shared that before Hazel, she could not give medication to students, and the health office did not have splints available. She thanked Hazel for helping her do more for students in need of care.
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Hazel is convenient and fast for families
A mother noticed her son was getting low on his asthma medication. She tried to schedule a visit with his doctor to refill his prescription, but all of the available appointments required her to take off from work, and her son would need to miss school. She needed to get her son to the doctor so he wouldn't run out of medicine, so she reached out to Hazel.

Hazel was able to see her son and send the refill to a local pharmacy within one day. The mother was happy that there was no need to interrupt school or work to get her son to a doctor for his medicine. She was also amazed at how easy and fast the entire process was.


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Student Story
A student was coughing and sneezing a lot, but her family wasn’t sure if she was sick or had allergies. Thankfully, her school used Hazel, and they could get an answer.

After talking with the school nurse and the Hazel provider about her symptoms and medical history, the student was happy to find out it was likely allergies. She got some medicine and returned to class feeling better.
Hazel gets students the right support quickly
During the pandemic, a high school student was having a hard time coping. He was sad about COVID-19 impacting his senior year, and he was worried about the state of the world. The student was also struggling with some personal conflicts, and he felt he didn't have the right support at home.

After discussing his feelings, a Hazel doctor connected him with resources that he described as “life-changing.” He was very grateful and shared that he didn't know where to go for help before Hazel.
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Parent Story
Shortly after COVID-19 began, a student began to develop tics. Her parents took her to a neurologist, but they wanted to get her into counseling as well. The student’s mother was having a hard time finding answers to her questions and didn’t know where to start the process, so she turned to Hazel.

The Hazel doctor listened as the mother shared her concerns and frustrations. Hazel reassured her that they would find the right services for her child. After the initial visit, the Hazel doctor partnered with the school counselor and the student’s mother to identify resources and counseling services that are a good fit.
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A physical health visit leads to an important discovery
A student came into the nurse’s office because his vision went blurry. The Hazel doctor looked at his eyes, but he did not see any injury. As he asked him questions about his symptoms, he started to sense that he was down about something. After a few minutes, the student shared that he was really sad because his mom was recently diagnosed with cancer. He explained that he feels worried, and it’s hard for him to focus.

Hazel called home, and the student’s mother confirmed her diagnosis. They discussed how to help manage the child’s stress, and Hazel offered to connect the child with counseling resources through the school. The mother was very grateful for the guidance and was eager to get her child help during a stressful time.
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Counselor Story
Hazel Health has been integral this year in getting our students the mental health services needed to help them live healthy lives.  The staff has been attentive, prompt, and resourceful. There is an evident sense of caring for the work they do and the students they serve. It has been a pleasure partnering with Hazel Health in providing mental wellness for our Garland ISD families.
Parents: Let us know you are interested in Hazel for your school
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We will reach out to your school district to let them know that parents at their school are interested in Hazel Health services.
Learn how Hazel can improve access to care for K-12 students
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A member of our team will be in touch to talk about how we partner with schools and school nurses to expand access to health services - whether students are learning in school or at home.
COVID-19: Learn how Hazel can improve access to care for K-12 students
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Hazel services are offered with $0 patient responsibility for all students through the 2020-21 school year for at-home or in-school doctor visits, due to these unprecedented times. Get in touch with us to learn more.
Let us know you are interested in adding Hazel to your insurance provider network
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Let us know you are interested in adding Hazel to your insurance provider network
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