The article provides a critical appraisal of the introduction of ‘Z-codes’ in the United States, which explicitly codify social determinants of health, such as illiteracy, unemployment, and poverty, as viable diagnostic categories. Introduced in 2016 by US government agencies, these codes aim to standardize the documentation of non-medical, social factors influencing patients’ health, building on similar approaches in Canada, the United Kingdom, Australia, and Scandinavia. While Z-codes hold promise in addressing patients’ social needs and formally implicating a broad set of social factors in poor health, the article contends that there are likely consequences to this medicalization of social determinants. Patients with Z-codes in their medical history tend to have worse health profiles and incur greater healthcare expenditures.
Iliya Gutin’s article, published in Sociology of Health & Illness, analyzes the implications of treating social determinants of health as a diagnostic category from the vantage point of the sociology of diagnosis. The author’s objective is to demonstrate the versatility of this theoretical framework for illustrating the fine line between using and misusing diagnoses in the pursuit of better individual and population health. The examination is structured around three core areas: how diagnoses provide legitimacy, how they formalize knowledge, and how they allocate responsibility in the context of social determinants of health. While acknowledging that Z-codes represent a “hard-won fruit” of sociology’s efforts to integrate social factors into medicine, the article also explores the potential pitfalls, such as the reinforcement of beliefs about individual responsibility for poor health at the population level and the limited capacity of diagnoses to capture the complex etiology of health.
Ultimately, the article argues that Z-codes cannot be simply categorized as “good” or “bad”. Instead, it frames diagnoses as “symptoms of systems,” suggesting that their success or failure is dictated by the broader social systems in which they are embedded, rather than inherent flaws in the diagnoses themselves. The US healthcare system, with its emphasis on bureaucratic legitimacy, individual responsibility, and treatment, significantly influences how Z-codes are acknowledged and utilized. The author suggests that diagnoses can either reflect the status quo or be aspirational, influencing societal norms about health and its causes.
Reference for this article: Gutin, I. (2024). Diagnosing social ills: Theorising social determinants of health as a diagnostic category. Sociology of Health & Illness, 46(S1), 110–131. https://doi.org/10.1111/1467-9566.13623
