Centers for Disease Control and Prevention (CDC) defines social determinants of health (SDH) as the conditions in the places where individuals live, work, and play that affect a wide range of health and quality of life-risks outcomes. That is, the context we live in greatly affects our health and our ability to improve our health outcomes.
Framework of social determinants of health
The US Department of Health and Human Services uses a place-based framework to identifies SDH. They are: Health care access and quality, education access and quality, social and community context, economic stability, and neighborhood and build environments. World Health Organization and many other studies have concluded that these factors are most likely responsible for the health inequality that exists within and between the countries. Here is a brief description of factors that affect health outcomes in each category.
| Categories | Factors that affect health outcomes |
| Health Care Access and Quality | Access to Health Care, Access to Primary Care, and Health Literacy |
| Education Access and Quality | Early Childhood Education and Development, Enrollment in Higher Education, High School Graduation, and Language and Literacy |
| Social and Community Context | Civic Participation, Discrimination, Incarceration, and Social Cohesion |
| Economic Stability | Employment, Food Insecurity, Housing Instability, and Poverty |
| Neighborhood and Built Environment | Access to Foods that Support Healthy Eating Patterns, Crime and Violence, Environmental Conditions, and Quality of Housing |
The question, however, remains is what are we doing to address these issues? How can we help people who are already negatively impacted by the existing circumstances in our society? To start with let’s look at some general facts about the US.
A recent study found that the widening economic inequality has exacerbated disparities in health outcomes. The life expectancy of the wealthiest Americans is 10-15 years more than their poorest fellow citizens. The current pandemic has nothing but worsens this situation. The US Census Bureau reports that in 2019, the poverty rate was 10.5%. The current figure for 2020 is expected to be much higher because of the pandemic. Additionally, the poverty rate is much higher among Hispanics (15.7%) and Black Americans (18.8). The poverty rate for children under the age of 18 is 14.4%. (https://www.census.gov/newsroom/press-releases/2020/income-poverty.html).
Health Insurance
According to Congressional Budget Office (CBO), 10.9% or 31 million adults had no health insurance in 2020 and the rate is much higher for the Black and Hispanic population. Additionally, 38 million have inadequate health insurance. Evidence shows that people without health insurance or inadequate health insurance are more likely to miss preventive healthcare for chronic conditions. Probably reasons could be lack of a primary care provider, higher out of pocket costs, or concern for medical debt. This makes them more likely to have poor health outcomes.
Food insecurity
People with disabilities, injuries, or conditions like arthritis may be especially limited in their ability to work. But poor people, even though they might have stable jobs still don’t earn enough to afford things they need leading to food insecurity. Today, 50 million Americans struggle with food insecurity. Food insecurity leads to an increased risk for poor health, infection, and malnutrition. Feeding America reports that almost 17 million children are likely to experience food insecurity because of COVID-19. Adults who face food insecurity may have an increased risk of negative health outcomes leading to frequent illness. Food insecurity and malnutrition in children can negatively affect their cognitive development which can lead to behavioral and emotional problems. This may further lead to some form of discrimination like bullying in school which leads to a higher likelihood of students dropping out of school or less likely to complete graduation. Whether adults or children, food insecurity eventually leads to reduced ability to work and lower economic stability.
Evidence shows that government programs like SNAP and WIC can have a positive impact and can promote increased parental care, improved infant weight, and nutrition, and access to food while reducing malnutrition. It has the potential to stop the vicious cycle of food insecurity and lower economic stability. Unfortunately, there are barriers like lack of information on eligibility, linguistic barriers, administrative barriers (e.g. multiple verification), and transportation barriers that prevent many children and families to participate in these programs.
Employment opportunities
Poverty, inadequate or no health insurance, combined with lack of employment programs, career counseling, and high-quality child care exacerbates the situation leading to negative health outcomes.
Build Environments
Poor people are more likely to live in an oppressive neighborhood and built environment such as exposure to violence, unsafe air or water, and/or higher exposure to allergens. They are also more likely to work in a loud and noisy environment. It is generally compounded by a lack of walkable or bikeable neighborhoods. Additionally, lack of social capital, social network, social support, and social cohesion negatively affects health outcomes.
Limitations of the current system
Once the health of individuals is compromised, even the highest quality of traditional medical care is not enough to improve health outcomes. Prescription for antibiotics does little when the cause of the problem is hunger, malnutrition, or bad living environments. Traditional medical care can be ineffective when the causes are not medical. Additionally, physicians fail to screen patients routinely for such unmet resource needs and other social determinants of health rendering medical care ineffective. Even though a large percentage of physicians recognize the need to address patients’ socioeconomic needs, only a small majority actually do. This is partly because doctors have few to no solutions to offer.
This clear disconnect and inability of our healthcare system to detect patients’ social determinants of health can be the biggest obstacle to achieving equal health outcomes for all over our citizens. It is a systematic issue that needs understanding at a broader level. Patients and families who need the resources are either unaware of government programs and government keeps pumping money that produces a little effective outcome. There are more than 80 programs that collectively spend more than a trillion dollars, yet the inequalities are on the rise. Often these solutions are created without any input from the people who these programs are supposed to help.
This is where social entrepreneurial organizations like Health Leads step in. They bridge this gap by helping physicians and families expand their diagnosis and screening the families to include these unmet resources needs. Trained volunteers work with physicians to identify basic needs such as food, housing, and childcare and connect patients and their families with the needed resources. The doctors along with the volunteers generate referrals to social work, legal services, or the Family Help Desk (Health Leads Volunteer Desk). They provide the additional layer of screening families with the social determinants of health in addition to medical determinants of health. Here is the systems map that illustrated how the social determinants of health create the interconnections and trap people in the vicious cycle of poverty.
Cite this article (APA)
Trivedi, C. ((2021, February 2). Social determinants of health. ConceptsHacked. Retrieved from https://conceptshacked.com/social-determinants-of-health/
