The Social Determinants of Health are a set of conditions in the environment that influence our health and well-being. These factors include social, economic, cultural, physical environmental, and political circumstances. This article will cover some financial and non-financial determinants which have implications on how healthy people are. We’ll also discuss solutions to this problem!
What are social determinants of health?
They are conditions in the environment influencing health and well-being. These factors include social, economic, cultural, physical environmental, and political circumstances.
Who is affected by these determinants?
Social Determinants affect all people to some degree, but they disproportionately impact those with fewer factors to buffer the effects of these circumstances.
The politics of health, or health policy, is the area of study concerned with “the distribution and responsibility for healthcare.”
Politics of Health
This includes how government and non-governmental organizations should allocate public funds to provide healthcare and protect against illnesses; how they should regulate medical care, devices, drugs, and other health information, and the consequences for individual rights. Health also touches on animal rights because research has shown that animals are a good model for many human diseases.
Health policies often have a significant impact on the economy and the people in that region or nation. The World Health Organization is a commonly used example of institutionally established health policy, other national-level government agencies. Regional and local governments also commonly legislate health policy.
Health policy can also be formed by non-government organizations and individuals, such as charities, advocacy groups, political parties, religious institutions or academic institutions, or non-profit organizations.
In the United States, health care is delivered in a highly decentralized fashion by multiple levels of government, including federal, state, and local governments, non-profit corporations and institutions, for-profit corporations and institutions, businesses outside of the healthcare sector, and individuals. The four major goals identified in the United States are “access to care,” “health outcomes,” “costs,” and “quality.”
In other countries such as Canada, there is less decentralization. In Canada, it is the province’s responsibility to provide care. A woman had to travel from New Brunswick to Montreal for cancer treatment because it was not available in her region. She died on the way to Montreal, but it is unclear if the outcome would have been different if she had stayed in her original area.
In a 2003 study, “the U.S. healthcare system performed poorly than other industrialized nations concerning health outcomes. The World Health Organization estimates that in 2004 the U.S. healthcare system ranked 20th in quality out of 191 countries and 17th in access out of 181 countries. The United States healthcare system had high rates of use for many services, particularly high among adults aged 19 to 64, but was ranked 37th in terms of efficiency.”
The pharmaceutical industry has been considered one of the most influential political lobbying groups within the United States. Spending by this industry on influence-peddling in Washington has risen to about $229 million a year.
It is important to also look at the socioeconomic factors that largely decide one’s health. This includes the level of income, education, and employment status to understand how they affect someone’s health outcomes effectively. It has been found that individuals who have higher levels of educational attainment experience lower mortality rates than those with less education. Likewise, people employed full-time have lower mortality rates than the unemployed.
A good example is shown by looking at a study of white and black males in the United States. It showed that white males were likely to live longer than black males. This was also a trend seen in poor, middle income, and rich unemployed or unskilled people. However, when you analyzed the socioeconomic status, they found that the difference between whites and blacks was not as large. This shows how socioeconomic status is related to health outcomes.
Our society is more unequal than it has been in decades. Social determinants of health are the conditions in which people live, work, and age that influence their health and well-being. The social determinants of health include income, education, living environment (home or neighborhood), employment status, gender identity, and expression, race/ethnicity as well as services in your community.
Socioeconomic Status (SES) is defined by the income, wealth, education, and social standing of a person or group of people within a society. This can refer to an individual’s or household’s own characteristics or to the characteristics of any institution in which they may be involved, including housing. Socioeconomic status broadly connects people’s lives to the wider society and economy, contributing to health inequality both within and between countries.
Many are privileged with good health in our society, while others are faced with poor health conditions. Health inequalities come in a variety of forms. Some of the most common that we see today include economic inequalities, racial disparities, and gender differences.
As one would expect, mortality rates primarily reflect the quality of life for the individual and other socio-cultural factors such as education levels or race. While overall mortality rates in the U.S. have been low, recent mortality rates have increased significantly due to increases in (mostly) preventable diseases such as diabetes, cardiovascular disease, and obesity. For example, life expectancy at age 65 for men in the U.S. is lower now than it was more than sixty years ago (6 years lower for black men).
In the United States, income level has a direct correlation to the rate of premature mortality. The higher the household income, the lower the risk of premature death. The association between household levels and mortality is more prominent in some states than in others. For instance, people living in Louisiana have an increased chance of dying prematurely if they are African American or low income compared to white or high income. This phenomenon is referred to as a “mortality gap.”
Another, more common, example of health inequality is racial disparities. In the United States, the race is often used as a proxy for socioeconomic status; however, this is not always the case. Many people assume that all African-Americans are poor or uneducated without even questioning whether or not the assumption was correct. In actuality, 15% of African-American families live below the poverty line, while 30% of white families do.
“So many of our problems are created by stupid people with a lot of power.” -Will Rogers
There is no doubt that various social factors play into the outcomes associated with health. However, for the most part, mortality can be correlated to demographics such as ancestry, education levels, and income. For example, a study published by the CDC found that the risk of mortality was greatest among those born in Tennessee compared to those born in other states.
Some cultural differences such as ethnic and racial traditions may have an impact on health. For example, a study published by the CDC found that Hispanic Americans are at a disadvantage when their mothers die during pregnancy or childbirth; however, the same study found that death rates were not different by ethnicity when one of their grandparents died.
The healthcare system does not and cannot completely compensate for social inequalities. In fact, recent studies have found that many inequalities are present even in the most developed countries. For example, a study published by the “New England Journal of Medicine” found that the poorest groups of individuals have the same or worse mortality rates than their richer counterparts, even in countries like Switzerland and France.
There are a host of cultural and socioeconomic factors that play a role in determining whether one will attain an education. Sociologists have posited that many people will choose not to pursue education if it means they will be forced to accept low-paying jobs or live at a poorer socioeconomic level.
Race, Ethnicity, and Discrimination
Race, ethnicity, and discrimination are all social determinants of health. The Social Determinant Model is a framework that suggests inequalities in society create an unequal distribution of power among various groups within the population. This creates an environment where people can be denied opportunities to make healthy choices such as eating nutritious food or getting quality healthcare coverage because they cannot afford them due to financial constraints.
Neighborhood and Place
An area is known as a “food desert” is a place where people cannot access healthy food choices for whatever reason. There are many reasons for this, such as distance to a grocery store, lack of quality roads and transportation options, and poor living conditions.
Food deserts exist in all 50 states and the District of Columbia. In 2014, the CDC evaluated places that are considered food deserts in every state. The study found that in 2014 over half a million more residents had easy access to fresh produce at their houses (18.6 million people) compared to people who lived in food deserts (17.8 million people).
That is a fascinating number!
More than 18.000 million people live in food deserts across the United States, which is over 10% of all Americans.
The Social Determinant “Place” refers to where we live and how much access we have to different resources or opportunities to influence our health outcomes. For example, one study found that people who lived in neighborhoods more connected to social services had a lower mortality rate than those who lived in isolated communities.
Another study also found a higher homicide rate among poor communities than those living in wealthy communities. The reason was that the poor community tended to have more crime associated with it when considering all the factors considered.
This Social Determinant “Education” refers to the level of education and knowledge someone has related to their health. For example, a study found that people who had less than 12 years of formal schooling were more likely to have chronic diseases like diabetes or heart disease than those who had at least some college education.
Focus on Health in Non-Health Sectors
The social determinants of health are not limited to the health sector. In fact, many social determinants influence our well-being, which is not even in the health sector. One example is neighborhood violence, leading to a host of problems, from mental illness to poor academic performance and self-esteem.
Another example is the education system and how it impacts mental conditions because being exposed to a stressful environment can lead to depression or other mental illness.
It is important to note that the education system affects not only those in school but also parents and children. Children of lower educational attainment were more likely to have chronic diseases like diabetes or heart disease than those who had at least some college education.
Why Social Determinants Matter
Since social determinants are linked to the physical health of individuals, healthcare providers need to include social determinants in their treatment. When we look at how depression and other mental illnesses are directly linked to a person’s environment, we can understand why it is important to address the social determinants of health.
Higher education attainment, living in affluent neighborhoods, higher income level, and having good access to healthy food choices have all been protective factors against mental illness.
In one study, Dr. Catherine Kennedy and her colleagues looked at a set of factors related to physical health, including education level, access to resources such as food stores in the area, employment status, and income.
The study found that those who were up against social determinants- like poverty or low levels of education were more likely to have depression than people with higher income and education levels.
Similarly, another study looked at the same connection between social determinants and mental illness but found that income was not associated with depression, while education and neighborhood quality was. This means that the higher a person’s education level or, the better a person’s neighborhood is, there is also a lower risk of mental illness.
The mental illnesses included in this study were mainly mood disorders such as major depressive disorder (MDD) or bipolar disorder (BD).
Addressing Social Determinants in the Health Care System
The World Health Organization (WHO) recommends that health care providers address social determinants in their treatment. They recommend that physical and mental health should be addressed at the same time rather than separately.
This is because addressing social determinants can provide a “double dividend” of improving physical and mental health. For example, when we look at diseases linked to poverty, such as tuberculosis, there are higher chances for drug resistance when the TB patient’s socioeconomic status is not considered during treatment.
Additionally, a study found that addressing social determinants can decrease depression and anxiety in patients. When they looked at how this integrated approach to health care impacts the quality of life for cancer survivors, it was clear when there were interventions to address both physical and emotional effects on their lives. They also observed a reduction in depressive symptoms among those treated or received further help by a social worker.
When talking about mental health, the Center for Mental Health and Human Development recommends that people be screened at least once a year. It also suggests that depression can be addressed first because it is the most common mental health disorder. According to Depression.org, in 2016, depression is also the second leading cause of disability in the United States.
Health care reform
In the United States, health care reform is a contentious issue. The Affordable Care Act was passed in 2010, and it has been amended since then to tackle some issues with the affordability of healthcare. One amendment allows people under 26 years old to stay on their parent’s insurance policies until they turn 26 if they would otherwise be dismissed from coverage because of age.
While the United States has reform, other countries do not. For example, in the United Kingdom, many people are getting sick due to air pollution, which is an indirect result of globalization.
According to one study conducted by a doctor and his colleagues from the University College London, pollution levels in parts of London are at dangerous levels. The study also found that healthcare spending is approaching $20 billion a year due to poor air quality.
Health care reform has addressed the problem of unaffordable health care coverage in the United States. However, many social determinants go beyond healthcare to include all of society. These social determinants are usually left out when discussing health reform.
This is an important issue because those who cannot afford to pay high premiums often cannot pay for their healthcare and their education, housing, and other daily necessities. One study found that adults without health insurance had a higher risk of suicide even after controlling for income.
The relationship between poverty and health
The link between poverty and health has been studied for years. One study found that people living in a poorer community had higher levels of anxiety and depression compared to those living in a wealthier community. They also had higher rates of substance abuse and thought about suicide more often than their counterparts.
Another study found that low-income individuals were more likely to smoke than their happier counterparts. The study also found that people who had lower educational attainment or experienced adverse childhood experiences were more likely to smoke than those who did not experience these things. The health implications of this are significant, with people who smoke have a higher risk of developing lung cancer.
The relationship between poverty and health is complex, but it can be summed up by the idea that poorer communities have fewer resources to manage their health than wealthier ones. They experience more stress because they are less likely to have adequate shelter or nutritious food for themselves and their families.
That pressure adds up over time, leading to a higher risk of depression and anxiety, which are both linked with poor health.
Poverty also affects the chances for children in these communities to have access to good education or recreational activities that can help them learn new coping skills and stay active as they get older. As adults, they may face more limited employment opportunities because of limited education and opportunities within their communities.
Where opportunities are available, they may be less likely to take them up due to their circumstances. A solution would have to deal with the determinants and underlying factors. Dealing with one and not the other may lead to temporary relief with no long-term benefits.
What are some possible solutions? One could be better access to education for low-income areas. It would also be the provision of food and other resources to those in education.
The quality of jobs directly impacts our health since they can influence both the availability of healthy food and exercise opportunities. A study from the National Cancer Institute found that long working hours are associated with poor diet and poorer sleep quality, leading to more sick days.
Another recent study looked at the link between retirement and health. The study found that retired people who were not forced to retire had better mental health than those forced into early retirement.
This determinant is not limited to the type of work that you do. It also includes the quality of work, such as whether or not you have a safe working environment.
Another way jobs can determine health is by affecting one’s ability to save and spend money on healthy food, exercise opportunities, etc.
* Improving education programs will help reduce unemployment rates in low-income areas, which would also improve access to healthcare
* Creating public transportation will make it easier for people to access fresh produce in the inner city.
* Creating more jobs in areas with high unemployment rates will benefit the economy and create more wealth in a community proven to affect health positively.
References and Further Reading