Nora is an active, healthy 27-year-old single mother. She became pregnant while in nursing school and stopped attending to care for her baby. Her child’s father left three years later. Nora works full-time as a paraprofessional at a local elementary school while her child is in school, so she doesn’t have to pay for childcare. However, the job doesn’t provide insurance, and her daughter was recently in the hospital because of an allergic reaction. Now, Nora has to work a second job to pay for the medical bills.
Now that Nora works 65+ hours a week, her daughter stays with her grandparents while Nora works. She has no time to cook healthy meals, so she eats more fast food. As a result, Nora is gaining weight and experiencing symptoms of high blood pressure but doesn’t have time to see her doctor or exercise. She also doesn’t have time to help her daughter with schoolwork. Her grandparents try to help, but her child falls behind in class.
This experience is real for millions of US citizens. Real people like Nora experience social barriers to health. Healthy People 2030 defines social determinants of health as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” Although decades of health research and efforts have focused on improving medicine, social determinants play a critical role in the well-being of people and communities. Here, the experts at Everyday Life Consulting explore the basics of social determinants of health and strategies to address them.
Protecting Your Community’s Health Starts with Social Determinants
What are the social determinants of health?
According to the Office of Health Policy, 47% of health outcomes are caused by socioeconomic factors, compared to 34% by health behaviors and 16% by clinical care. These statistics demonstrate the crucial role that social determinants play in our health. The social determinants of health provide a lens to analyze health from a whole-person perspective. Consider Nora’s story. From a medical perspective, her weight gain and high blood pressure are easily addressed by eating healthier foods and exercising. However, Nora had poor access to healthcare and limited economic stability, resulting in her working multiple jobs. These social determinants of health prevented her from living well.
The Centers for Disease Control and Prevention define social determinants as “the nonmedical factors that influence health outcomes.” Social determinants deal with the systems, policies and barriers that prevent people from living well – beyond the traditional sense of medicine. For example, type 2 diabetes is preventable and treatable. However, social factors might inhibit someone from treating diabetes, such as limited access to healthcare and healthy foods, poor health literacy, and limited income.
Social determinants can also create good outcomes. For example, there are more walking trails, better food options, safer childcare, and better education systems in wealthier communities. Access to those resources makes it easier to live well. Unfortunately, these good outcomes are limited to specific communities. Many people of color and minoritized individuals, including low-income families, are disproportionately affected by negative socioeconomic factors.
What are some examples of social determinants?
There are five critical domains of social determinants. The World Health Organization and Healthy People 2030 have focused on the following domains.
- Healthcare access and quality: Access to reliable, affordable healthcare is necessary for people to live their best lives. When people cannot access healthcare, they may skip routine doctor visits and forego medications, leading to worse health outcomes. They’re also more likely to use the ER for non-emergency concerns.
- Education access and quality: We can improve people’s health outcomes by educating them on healthy skills, financial literacy, and more. Without quality education, people don’t acquire the skills to understand health instructions, make healthy decisions, and engage in healthy relationships.
- Social and community context: People cannot be healthy in unsafe communities; exposure to violence, trauma, and stigma has physiological effects that make people less healthy. That means efforts to address racism, violence, and more are crucial to overall health.
- Economic stability: Economic stability ensures people have access to healthy foods, healthcare, resources, and more to live their healthiest lives.
- Neighborhood and built environment: Our built environment dictates what resources we access. For example, living in a food desert means it’s much harder to eat a balanced diet. Living in rural areas means it’s harder to access healthcare. Healthy food sources, walking trails, and better transportation make health more accessible.
What do we know about addressing social determinants?
Research has shown that upstream prevention efforts – meaning efforts to reduce adverse health outcomes well before they occur – are effective. Upstream prevention strategies include improving education, enhancing health literacy, increasing wages, and building resilience. When we implement these strategies early in people’s lives, they are less likely to experience socioeconomic barriers.
The United States Office of Health Policy has published a guide on addressing social determinants of health. This comprehensive guide shows that access to quality childcare and education early in life leads to better health outcomes. It also indicates that non-emergency medical transportation increases the use of preventive medical services across all age groups, which can reduce unnecessary medical costs and debt. Additionally, “healthy food environments, public benefit programs, health care systems, health insurers, and evidence-based nutrition standards can lower health care costs.” We make a bigger impact by changing our standards and conversations around health to consider the social determinants.
We also know community health workers (CHWs) are valuable for addressing social determinants. For example, the National Institute for Health Care Management explains that CHWs can identify and address the root causes of adverse health and social outcomes. CHWs provide services such as informal counseling, healthcare navigation, advocacy and more. The CHW can help clients manage the following:
- Unstable housing
- Food insecurity
- Racial discrimination
- Intimate partner violence
In the past few decades, we’ve learned a lot about social determinants of health. However, there’s still more to learn. As public health funding increases, new prevention and intervention strategies will emerge.
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All healthcare and public health workers, including doctors, nurses, allied health professionals, and navigators, should be educated on the social determinants of health. Prescribing medication alone won’t address the root causes of preventable illnesses. When we address people’s barriers, we ensure our recommended treatments and health interventions are effective. Register for training on social determinants of health today with Everyday Life Consulting. Or send us a message to create a private training program for your organization or team.