Social determinants of risk

Social determinants of risk

This page covers high-impact risks driven by environment, relationships, stigma, and socio-economic conditions. These are not “personal choices” in a simple sense; they are often structural, chronic, and cumulative.

Not all risk is biological. Some of the most powerful determinants of health and life outcomes sit outside medicine entirely. These risks are often chronic, cumulative, and unevenly distributed across populations.

Adverse upbringing and relationships

Abusive childhood environments, coercive or violent relationships, and chronic emotional stress increase long-term risk for mental illness, cardiovascular disease, substance use, and reduced life expectancy. The harm is often invisible and delayed.

Domestic violence and abuse

Domestic and intimate partner violence dramatically increases risks of injury, chronic disease, depression, suicide, and homicide. Leaving abusive environments can itself be a high-risk period, requiring social and legal support as well as personal safety planning.

Socio-economic disadvantage

Poverty, insecure housing, food insecurity, and unstable employment are among the strongest predictors of poor health outcomes. These factors compound medical risk by limiting access to care, increasing stress load, and reducing recovery capacity after illness.

Discrimination and minority stress

Discrimination based on race, ethnicity, disability, religion, or migration status creates chronic stress and barriers to care. For many minority groups, risk is not only higher—it is structurally embedded.

LGBTQIA+ risk amplification

LGBTQIA+ individuals face higher rates of depression, anxiety, substance use, and suicide attempts, driven largely by stigma, discrimination, and social exclusion rather than identity itself. Protective environments and affirming care substantially reduce these risks.

Addiction, alcohol, and drugs

Alcohol and drug use can transition from coping mechanism to dominant risk driver. Risks include overdose, accidents, violence, liver disease, cardiovascular disease, mental health deterioration, and loss of employment and relationships.

Overdose and neglect risk

Overdose risk rises with tolerance changes, mixing substances, isolation, and lack of emergency response. Neglect—missed appointments, untreated conditions, and disengagement from care—often accompanies addiction and depression, further accelerating harm.

Employment loss and identity disruption

Job loss and occupational injury affect far more than income. They alter identity, social networks, access to insurance, and future opportunity. The downstream health effects can persist for years.