There is more that influences a person’s health than the healthcare they receive. An individual’s behavior can influence health as well, such as smoking, eating fast food, exercising, and getting a college degree; however, even these behaviors are influenced by factors often outside one’s control and at the discretion of those in power, most notably in the setting of systemic racism.
From the Office of Disease Prevention and Health Promotion, social determinants of health are “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” per its website for Healthy People 2030.
For the purposes of Healthy People 2030 (which “sets data-driven national objectives to improve health and well-being over the next decade”), these environmental conditions (aka social determinants of health) are grouped into five domains:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood Built Environment
- Social and Community Context
These social determinants of health are complex, interconnected, and influence health across one’s life span and across generations. For example, a person with a college degree may be more likely to have a safe and stable job with health insurance benefits, that affords living in a neighborhood with a culture of healthy living (i.e., outdoor exercise and avoiding smoking) as well as access to grocery stores with healthy food. These factors would add together and make it more likely for this individual to exercise, refrain from smoking, utilize preventative healthcare, and make healthier food choices. The determinants that this person lives under will likely equate to a longer, healthier life for themselves and opportunity to pass on socioeconomic benefits to the next generation. Even in this example, there were already influential factors that lead to the successful completion of higher education.
It becomes easy to see that barriers to access to any one of the five domains listed above will cause detrimental effects on one another and ultimately lead to a decline in health. This is evidenced by the negative health effects of systemic racism and discrimination which explains why the detrimental effects of COVID-19 are disproportionately felt by racial and ethnic minority groups. The explanation of higher rates of diabetes and heart disease in these groups is not the end of the story. Social determinants of health are social constructs (not the product of genetics) that explain why there are higher rates of diabetes and heart disease that make some populations more vulnerable to COVID-19.
As a healthcare provider your duty to positively affect the health of those around you should move you to investigate how these conditions can be mitigated. For more information, providers can explore the national health objectives regarding social determinant of health and the CDC’s Tools for Putting Social Determinants of Health into Action to see what action can be taken to improve your patients’ and even your community’s health.