Americans of different demographics, ethnic groups, financial classes, and education often receive differing levels of care from the American health system. It’s not difficult to see how this isn’t equitable, as lofty human rights ideals seem to have little to do with the way the most advanced healthcare system in the world actually functions.
There are so many reasons for these disparities that sometimes it can seem impossible to parse. Luckily, there is an entire school of thought designed around isolating the factors that make the most impact on differing levels of care and correcting them.
Central to this practice is the concept of Social Determinants of Health (SDH). These are defined by the U.S. Department of Health and Human Services to be “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.” Broken down further, they fall into five subgroups: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context.
Together, these categories encompass everything that affects the healthcare system’s treatment of different individuals and groups.
Why Do the Social Determinants of Health Matter?
These aspects are important because they allow those who study the healthcare system to quantify the effects of unique variables on certain populations. For example, living in or around certain areas might radically affect a group’s health outcomes. Some cities in the U.S. have great healthcare networks that are more accessible to even poorer groups. Other cities or rural regions lack that same access and thus negatively impact the health outcomes of the people who live there. By quantifying and noticing these discrepancies, we can begin to make beneficial changes that can increase quality of life and life expectancy.
But how much do they matter? The answer is shocking.
According to the World Health Organization (WHO), SDH account for between 30-55% of all total health outcomes. This means that SDH are statistically more important than either healthcare intervention and lifestyle choices to overall outcomes. This leads to some surprising findings. For example, it is statistically possible that lifetime smokers who have high quality SDH can often have better outcomes than people who have lower quality SDH but have never smoked.
In fact, the WHO found that “the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.” In layman’s terms, this means that healthcare is statistically less important than the other factors that surround you in your life. Many of these may be fundamentally out of your control as an individual.
Understanding and Rectifying Inequity
The SDH matter so much because they can show us connections between negative health outcomes and variables that we might not have ordinarily considered relevant to the conversation.
High quality food access is a good example. A lot of people don’t realize that eating healthy is quite expensive. A relatively affluent American family living in a mostly middle class neighborhood might not recognize that the food they buy and eat every day is inaccessible to other less well-off people. By and large, people who can’t afford to eat healthy foods are forced to eat quick, cheap, and unhealthy foods. This leads to chronic problems such as diabetes, heart disease, obesity, cancer and other major problems.
Physical location matters a lot too. Even if a family living in a poorer area has the budget and time to eat well, they may not live a reasonable distance from a store where they can buy fresh vegetables, or other essential healthy foods with which to make meals.
Opportunity cost plays into this as well. A two parent family in which both parents work full time might have enough money to eat well, but can’t afford the time it takes to travel to a grocery store, buy the food, and make dinner every night.
SDH represent systematic issues in our society that often get worse instead of better, trapping families in poverty. Once a family member becomes chronically ill with one of the aforementioned conditions, taking care of that person becomes increasingly expensive as well. In other words, even a quick glance at the ramifications and trends that SDH suggest show us that in the long term, it can be extremely expensive to be poor and unhealthy, while it’s comparably less expensive to eat well. These are not lifestyle choices, they are external conditions.
The social determinants of health can provide us with insight into the way our society works below the surface. While it may look like good health favors the middle and upper classes because of healthy lifestyle choices, the study of SDH tells us that this is not true. Once contextualized within the larger picture of our society, it becomes clear that if left unchecked, these factors collectively work to generationaly keep people unhealthy, and below the poverty line. It’s only by careful attention and long term work that we can start to reverse this process, and institute a better form of health equity throughout the U.S. and the rest of the world.
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