Why social determinants of health matter

Little Boy on Slide
Little Boy on Slide

Strategies for Well-Being

Social Determinants of Health are the areas of your social and environmental condition and experiences that directly impact your health and health status.

Ask any care coordinator and you will hear story after story of patients whose clinical status was affected by challenges, such as access to care, socioeconomic or educational status, cultural norms and beliefs, and even their own living environments. Traditionally, these challenges are more familiar to those in public health fields rather than those with more clinical or health care administrative backgrounds. However, it is critical to have a deep understanding of the social determinants of health and how they affect every aspect of your health.

Health starts in our homes, schools, workplaces, neighborhoods and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.

Many studies have shown a direct correlation between where a child lives and his or her future economic opportunities as an adult. A person’s health is determined by more than just access to health care. Social and behavioral factors contribute more than 60 percent of an individual’s health status. Research shows that health behaviors such as smoking, and diet and exercise are most determinants of premature death. Whether someone is able to engage in healthy behaviors is largely determined by a range of social, economic and environmental factors.

Research shows that health disparities are the greatest in poor neighborhoods populated with people of color. These groups have the highest levels of chronic disease and many other conditions.

Keep in mind that this phenomenon happens, particularly, in major cities where some of the world’s top medical and research institutions reside. Yet, one segment of the population enjoys healthy existences, while others, in the same city languish in sickness with poor health outcomes. It certainly can’t be due to the services and treatments needed don’t exist.

Across the United States, one thing is clear, it has everything to do with ZIP codes.

In Chicago, life expectancy can differ by as much as 16 years between just seven stops on the “L,” between the Loop and Washington Park. In Philadelphia, the 5 miles that separate Society Hill from North Philadelphia can add or subtract 20 years from your life. In New York City, if you reside near the Mets’ Citi Field, you will live on average seven years longer than if you live near Yankee Stadium. That has nothing to do with the fortunes of the teams. These are some of the dramatic findings from research conducted by the Virginia Commonwealth University Center on Society and Health and the Robert Wood Johnson Foundation.

Some neighborhoods have more liquor stores than grocery stores, lack safe and affordable housing, or have poor quality schools. And many urban and rural areas have experienced generations of isolation from opportunity.

For some of these neighborhoods the social determinants of their health clearly pose monumental challenges. It would be easy to say that we can’t change the conditions where some people live and work.

In low-income neighborhoods, patients with diabetes are 10 times more likely to undergo limb amputation than those in affluent areas. Compared to white Americans, the rate of hospitalization for patients with diabetes is twice as high for Latinos and three times higher for African Americans.

The death rate from breast cancer for African American women is 50 percent higher than for White women. Racial and economic inequities in screening and treatment options contribute to this divide. In the U.S., 60 percent of low-income women are screened for breast cancer versus 80 percent of high-income women. But even within the same economic stratum, white women have higher screening rates than African American and Latino women.

Among health care officials, there’s broad agreement that these inequities exist. There’s less agreement about the reasons for them or how to narrow the gaps.

But there’s a lot to be gained even through small changes. And over time, those changes can alter a person’s odds of dying an unnecessary, early death to one that favors a long, healthy life.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible!

Disclaimer: The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Glenn Ellis is a Health Advocacy Communications Specialist and is available through http://www.glennellis.com.

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