The Problem
Jamal and Cody go to the same school and have become best friends despite living in different neighborhoods. Cody lives in a rich neighborhood right next to a grocery store. His parents cook healthy dinners every night. Jamal, on the other hand, lives in a poorer neighborhood and the closest grocery store is a twenty minute drive. Because it’s hard to make time to drive to the distant grocery store, Jamal’s family often resorts to eating fast food from places nearby.
Explanation
Even though Cody and Jamal are both healthy right now, the neighborhood they grow up in will have important effects on their health. In the long run, eating more fast food will harm Jamal’s health. The idea that your environment can impact your health is considered a social determinant of health.
Social Determinants of Health
Social determinants of health are conditions in the environment that affect a person’s health outcomes and overall quality of life. These include healthcare access and quality, education access and quality, social and community context, neighborhood and built environment, and economic stability. Each of these factors influences what people put into their bodies, if and when they seek healthcare, and the amount of stress their body faces, which affects their overall health outcomes.
How It Works
Healthcare access and quality refers to a person’s ability to access high quality medical care. 1 in 10 Americans don’t have health insurance and many more lack access to affordable healthcare and often have to choose between medical care and crippling debt. If a person doesn’t have health insurance, they’re unlikely to go to the doctor when they are in pain. The longer a person waits to seek medical care, the longer a disease can wreak havoc on the body, putting them in worse health.
On the surface, education quality may not seem related to health outcomes, however it has a major impact on health. Children who don’t learn adequate math and reading skills are less likely to graduate high school or college. This means they are less likely to get a high paying job, which means they are more likely to develop chronic illnesses such as diabetes. Furthermore, poor education about healthy habits during childhood makes it harder for people to develop those habits during adulthood.
Social and community context refers to the social aspects of a person’s neighborhood and community. For example, someone who lives in an overpoliced community is likely to face more stress. When a person lives in a stressful environment, their immune system is repressed, they’re more likely to have high blood pressure, and they are at increased risk for a heart attack or a stroke.
Neighborhood and built environment on the other hand refers to the physical aspects of one’s environment that can affect their health. For example, if someone’s home is near a factory, they are exposed to pollution. This can cause respiratory diseases such as COPD and lung cancer, and also exacerbate pre existing conditions like asthma.
Lastly, economic stability refers to how a person’s financial resources affect their health. Economic stability is at the root of all the other social determinants of health. It determines where a person can afford to live and if they can afford medical care and other things necessary to maintain good health. Most importantly, financial instability can lead to chronic stress which harms the entire body.
Why Care?
These social determinants of health go hand in hand with socioeconomic status and race. The life expectancy for someone in the top 10% of the US is 88 years compared to 76 years for those in the bottom 10%. Furthermore, the average life expectancy for a white person in the US is three years more than that of a Black person. Income inequality and de facto segregation leads to poorer health outcomes for disadvantaged groups.
No matter how much medical science advances, social factors will always affect health outcomes. Therefore, we cannot improve the health of our population without addressing underlying social determinants of health. This can only happen through large scale change to undo centuries of systematic racism and inequality.
