Social Determinants of Health
When a patient comes into your clinic, their chief complaint may be “Low Back Pain”, but they also come in with their lived experiences. These experiences may feed into their discomfort, disease, and disability. Social Determinants of Health describe how the circumstances in which one grows, lives, works, and ages, and the social and economic policies that factor into these circumstances feed into health inequities. (1)
5 Determinants Areas:
Economic Status: Employment, Food Insecurity, Housing Instability, Poverty
Education: Early Childhood Education, Higher Education, High School Graduation, Language and Literacy.
Social and Community Context: Civic Participation, Discrimination, Social Cohesion
Health and Health Care: Access to Health Care, Access to Primary Care, Health Literacy
Neighborhood and Built Environment: Access to Foods that Support Healthy Eating Patterns, Crime and Violence, Environmental Conditions, Quality of Housing
Impact of Social Determinants of Health:
Black Americans have a higher rate of stroke. Black Americans are also exposed to the systemic stressors of racism which contributes to higher rates of hypertension, the leading risk factor to stroke. (3)
Poor Americans have a higher prevalence of obesity, due in part to poor neighborhoods’ lack of healthy food options and safe outdoor space. Additionally, poor people are more likely to work manual labor jobs due to lack of access to higher education. Both increase the load on joints and their degeneration, contributing to higher rates of osteoarthritis. (4,5)
People who are uninsured are less likely to seek both preventive care and services during the early stages of disease due to the cost burden. This prevents primary and secondary interventions, leading to higher rates of chronic diseases and is further compounded by lower rates of health literacy. (6)
COVID -19 has further exposed the link between societal inequalities and health outcomes with those at the intersection of race, ethnicity, and socioeconomic status, combined with poor health status due to comorbidities and lack of access being the most disadvantaged and at risk in the United States during this pandemic. (7)
While these impacts were studied in the United States, the ramifications of inequality and injustice on societies’ health are not strictly an American problem.
How to Help:
Learn more about how inequities, prejudices, and disenfranchisement can play into an individual’s and society’s health.
Listen:
NYT’s 1619 Podcast: Episode 4: “How the Bad Blood Started”
APTA NEXT 2018 Podcast: “Addressing Social Determinants of Health” by Rupal Patel
NPR’s Code Switch Podcast: “The United States' Pre-Existing Conditions” discussing Covid-19 in the context of racial and economic disparities
Watch:
Unnatural Causes: Is inequality making us sick?: A 7 part documentary series produced by NACCHO and published by PBS.
Ted Talk: A Recipe for Health Equity in the 21st Century: Renaisa Anthony
Ted Talk: Change the odds for health: Anthony Iton
Read:
2019 APTA Magazine article: “Addressing Social Determinants of Health” by Christine Lehmann
The Health Gap: The Challenge of an Unequal World, by Michael Marmot
Discuss with your colleagues/peers/classmates how the social determinants of health may play a role in your patients’ health, and how you can best meet the needs of your community.
Take Action! Partner with an organization or create your own sustainable service to combat the societal inequities that feed into your community’s health disparities.
Advocate: Whether it be as small as increasing safety by fixing street lights in a park, or as large as funding international programs that strive to minimize inequities, your voice can make a difference.
Donate: Financial or physical donations can go a long way in helping folks and creating change.
Serve: From volunteering in an afterschool program, to serving at your local food bank, or creating programming to assist in navigating the healthcare system, there are numerous ways to create positive change based on your own talents and your community’s needs.
As the WHO states, “Social Justice is a matter of life and death” (1). In order to best improve the function of our patients and our larger communities, we must not only treat the individual but also combat the societal inequities that feed into health disparities. Through sustainable service and advocacy at a local level we can combat the social determinants of health and create a healthier and more equitable society, together.
Sources and More Information:
