---
name: social-determinants-of-health-root-cause-mapper
description: "Maps a described health outcome or disparity to its upstream root causes across all five Healthy People SDOH domains — economic stability, education access, healthcare access, neighborhood/built environment, and social/community context — using a five-whys causal chain, a systems map of reinforcing loops, and a set of ranked intervention leverage points. Use when diagnosing why a health disparity persists, designing an upstream prevention program, building a grant case for social-impact funding, or moving a community health strategy from symptom to structural cause."
argument-hint: "[health-outcome] [population]"
allowed-tools: ["Read"]
---

# Social Determinants of Health Root Cause Mapper

## Purpose
Trace a specific health outcome or disparity backward through the five SDOH domains to its structural root causes, then surface the reinforcing feedback loops that keep the problem entrenched and the highest-leverage points to intervene. Moves program design from treating downstream symptoms to naming the upstream conditions that produce them.

## When to Use
Invoke this skill when the user asks to:
- Understand why a specific health disparity persists in a population despite past interventions
- Design an upstream or prevention-focused public health program
- Build the "root cause" or "theory of change" section of a grant proposal or foundation strategy
- Map how economic, educational, environmental, and social factors combine to drive a health outcome
- Identify where to intervene in a complex community health problem for maximum systemic effect
- Move a stakeholder conversation from symptom-blaming to structural analysis

## Inputs Required
Before starting, collect:
- **Health outcome or disparity**: The specific outcome being addressed (e.g., "Type 2 diabetes rates 2x higher among residents of ZIP 60624 than county average")
- **Population and place**: Who is affected and where — demographics, geography, community size
- **Known contributing factors**: Anything the user already suspects or has data on
- **Existing interventions**: Programs already in place and how they've performed
- **Available levers**: What the organization can actually influence (funding, policy, services, partnerships)
- **Data or evidence on hand**: Any local statistics, community input, or assessments
- **Strategic horizon**: Timeframe and scale the plan must fit (e.g., 3-year grant, county-wide initiative)

If population/place or existing interventions are missing, proceed with the outcome alone and flag that local specificity should be layered in from community data.

## Instructions

### Step 1: Frame the Outcome as an Effect, Not a Cause
Restate the presented problem as a measurable downstream effect, and separate it from behaviors and conditions that are themselves effects.
- Distinguish the **outcome** (disease, mortality, disparity) from **proximate behaviors** (diet, screening rates, medication adherence) — behaviors are intermediate, not root.
- Name the **disparity axis** explicitly: who has worse outcomes relative to whom, and by how much.
- Set the analytical rule: keep asking "what produces this?" until reasons land on conditions and policies, not individual choices.

### Step 2: Map Root Causes Across the Five SDOH Domains
For each of the five Healthy People 2030 SDOH domains, identify 2–4 upstream drivers specific to this outcome and population. For each driver, note the causal mechanism linking it to the outcome.

**Domain 1 — Economic Stability**
Employment, income, poverty, expenses, medical debt, food security.
- Mechanism examples: unstable income → food insecurity → cheap calorie-dense diet; medical debt → deferred care.

**Domain 2 — Education Access & Quality**
Early childhood education, literacy, high school completion, health literacy, language.
- Mechanism examples: low health literacy → misread symptoms → late diagnosis; educational attainment → job quality → insurance access.

**Domain 3 — Health Care Access & Quality**
Insurance coverage, provider availability, distance/transport, culturally competent care, preventive service uptake.
- Mechanism examples: no nearby primary care → ER-dependent care → no chronic disease management.

**Domain 4 — Neighborhood & Built Environment**
Housing quality, food environment, air/water/lead exposure, walkability, violence, transit.
- Mechanism examples: food swamp (fast food density, no grocery) → limited healthy options; housing instability → chronic stress.

**Domain 5 — Social & Community Context**
Social cohesion, discrimination, incarceration, civic participation, isolation, structural racism.
- Mechanism examples: experienced discrimination → medical mistrust → care avoidance; weak social networks → isolation → poor self-management.

For each driver, tag it as **structural** (policy/system), **institutional** (organizational practice), or **interpersonal** (relational/individual-level) to keep the analysis anchored upstream.

### Step 3: Build the Causal Chain (Five Whys)
Take the two or three most significant drivers and run a five-whys chain on each, ending at a root cause that is a policy, resource-allocation, or structural condition — not a personal failing.
- Format each chain as: Outcome → Why 1 → Why 2 → Why 3 → Why 4 → Root cause.
- Stop when the answer is something a program or policy could change, and note whether the root sits inside or outside the organization's control.

### Step 4: Identify Reinforcing and Balancing Loops
Apply systems thinking to show why the problem sustains itself.
- **Reinforcing loops (vicious cycles)**: Name 2–3 self-perpetuating loops (e.g., poor health → missed work → lost income → worse food access → worse health). Label each loop.
- **Balancing loops**: Identify any existing forces that push back (safety-net programs, community assets) and note where they are overwhelmed.
- **Cross-domain interactions**: Highlight where drivers in different domains compound (e.g., transport gap + provider shortage = access collapse).

### Step 5: Rank Leverage Points
Using a leverage-point lens (shallow: parameters/services → deep: rules, information flows, goals, paradigms), rank 5–7 intervention points by depth of impact and feasibility given the user's available levers.
- For each: what it changes, which loop it breaks, which domain(s) it touches, and its impact/feasibility rating (High/Medium/Low each).
- Distinguish **downstream** (mitigates effects), **midstream** (changes conditions), and **upstream** (changes policy/structure) interventions so the user can balance quick wins against durable change.

### Step 6: Synthesize a Root-Cause Statement and Priorities
Deliver a one-paragraph structural diagnosis and a short priority list.
- State the core structural root cause(s) in plain language.
- Recommend 3 priority leverage points, sequenced, with a note on which reinforcing loop each breaks.
- Flag the single most important data gap to close before committing resources.

## Output Format
- **Structure**: Diagnostic document flowing from reframed outcome → domain map → causal chains → systems loops → ranked leverage points → synthesis
- **Length**: 1,100–1,500 words
- **Format**: Structured prose with a domain-by-domain map (grouped bullets), causal chains shown as arrow sequences, and leverage points in a ranked table
- **Sections**: Reframed Outcome → Root Cause Map by SDOH Domain → Causal Chains (Five Whys) → Systems Loops → Ranked Leverage Points → Root-Cause Synthesis & Priorities
- **Tone**: Public health strategist — structural, equity-grounded, systems-literate; names root causes without blaming affected populations

## Quality Checklist
Before delivering output, verify:
- [ ] All five SDOH domains are addressed with at least 2 drivers each
- [ ] No driver stops at individual behavior — each traces to a structural, institutional, or interpersonal condition
- [ ] At least 2 five-whys chains end at a policy or structural root, not a personal failing
- [ ] At least 2 reinforcing loops are named and labeled
- [ ] Leverage points are ranked and each is tagged downstream/midstream/upstream with impact and feasibility ratings
- [ ] The synthesis names a specific structural root cause and 3 sequenced priorities, not a generic call for "more resources"

## Notes
- The most common failure in SDOH work is stopping at proximate behaviors (diet, adherence) and labeling them "root causes" — enforce the "keep asking why until you reach a condition or policy" rule.
- Upstream leverage points have the highest impact but the lowest feasibility for most single organizations; a strong plan pairs one upstream advocacy play with one or two midstream interventions the org can execute now.
- Cross-domain compounding is where disparities concentrate — the interaction of transport, provider shortage, and food environment usually matters more than any single domain in isolation.
- When local data is thin, treat the map as a hypothesis structure and recommend community listening sessions to validate which loops are actually operating.

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## How to use this skill

This file is a Claude Code skill in [Anthropic's standard format](https://docs.anthropic.com/en/docs/claude-code/skills) — markdown with YAML frontmatter at the top.

**Installing in Claude Code:**
- `~/.claude/skills/<folder-name>/SKILL.md` — auto-loads in every session anywhere on your machine (recommended for skills you'll use across multiple projects)
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Restart Claude Code or open a new session to register.

**Using in Claude.ai, ChatGPT, Gemini, or other AI tools:**

1. Drag this file into a new chat, or copy and paste its contents
2. Send your task or request as your next message — the AI will apply the skill where it fits

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