Social Determinants of Health

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Leaving technology and software/hardware industry for a healthcare 8 years ago really opened my eyes to how healthcare works and the industry overall. There have been great initiatives over the years where healthcare focus is more on prevention and management Vs over-prescribing and over-medication ,as well as understanding what drives the ever increasing cost of the healthcare. This is great initiative showing promise to improve health as well as access to health care to those who were unable to do so int he past.

Goal

Create social and physical environments that promote good health for all.

Overview

Health starts in our homes, schools, workplaces, neighborhoods, and communities. We know that taking care of ourselves by eating well and staying active, not smoking, getting the recommended immunizations and screening tests, and seeing a doctor when we are sick all influence our health. Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods, and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food, and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.

Healthy People 2020 highlights the importance of addressing the social determinants of health by including “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade. This emphasis is shared by the World Health Organization, whose Commission on Social Determinants of Health in 2008 published the report, Closing the gap in a generation: Health equity through action on the social determinants of health. The emphasis is also shared by other U.S. health initiatives such as the National Partnership for Action to End Health Disparities  and the National Prevention and Health Promotion Strategy.

The Social Determinants of Health topic area within Healthy People 2020 is designed to identify ways to create social and physical environments that promote good health for all. All Americans deserve an equal opportunity to make the choices that lead to good health. But to ensure that all Americans have that opportunity, advances are needed not only in health care but also in fields such as education, childcare, housing, business, law, media, community planning, transportation, and agriculture. Making these advances involves working together to:

  • Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities.
  • Establish common goals, complementary roles, and ongoing constructive relationships between the health sector and these areas.
  • Maximize opportunities for collaboration among Federal-, state-, and local-level partners related to social determinants of health.

Understanding Social Determinants of Health

Social determinants of health are conditions in the environments in which 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. Conditions (e.g., social, economic, and physical) in these various environments and settings (e.g., school, church, workplace, and neighborhood) have been referred to as “place.” In addition to the more material attributes of “place,” the patterns of social engagement and sense of security and well-being are also affected by where people live. Resources that enhance quality of life can have a significant influence on population health outcomes. Examples of these resources include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.

Understanding the relationship between how population groups experience “place” and the impact of “place” on health is fundamental to the social determinants of health—including both social and physical determinants.

Examples of social determinants include:

  • Availability of resources to meet daily needs (e.g., safe housing and local food markets)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation options
  • Public safety
  • Social support
  • Social norms and attitudes (e.g., discrimination, racism, and distrust of government)
  • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
  • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
  • Residential segregation
  • Language/Literacy
  • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
  • Culture

Examples of physical determinants include:

  • Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change)
  • Built environment, such as buildings, sidewalks, bike lanes, and roads
  • Worksites, schools, and recreational settings
  • Housing and community design
  • Exposure to toxic substances and other physical hazards
  • Physical barriers, especially for people with disabilities
  • Aesthetic elements (e.g., good lighting, trees, and benches)

By working to establish policies that positively influence social and economic conditions and those that support changes in individual behavior, we can improve health for large numbers of people in ways that can be sustained over time. Improving the conditions in which we live, learn, work, and play and the quality of our relationships will create a healthier population, society, and workforce.

Healthy People 2020 Approach to Social Determinants of Health

A “place-based” organizing framework, reflecting five (5) key areas of social determinants of health (SDOH), was developed by Healthy People 2020.

These five key areas (determinants) include:

  • Economic Stability
  • Education
  • Social and Community Context
  • Health and Health Care
  • Neighborhood and Built Environment

a diagram of the five social determinants of health

Each of these five determinant areas reflects a number of key issues that make up the underlying factors in the arena of SDOH.

  • Economic Stability
    • Employment
    • Food Insecurity
    • Housing Instability
    • Poverty
  • Education
    • Early Childhood Education and Development
    • Enrollment in Higher Education
    • High School Graduation
    • Language and Literacy
  • Social and Community Context
    • Civic Participation
    • Discrimination
    • Incarceration
    • Social Cohesion
  • Health and Health Care
    • Access to Health Care
    • Access to Primary Care
    • Health Literacy
  • Neighborhood and Built Environment
    • Access to Foods that Support Healthy Eating Patterns
    • Crime and Violence
    • Environmental Conditions
    • Quality of Housing

This organizing framework has been used to establish an initial set of objectives for the topic area as well as to identify existing Healthy People objectives (i.e., in other topic areas) that are complementary and highly relevant to social determinants. It is anticipated that additional objectives will continue to be developed throughout the decade.

 

Thanks For Reading

Marijan Pavisic MS SPHR

 

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