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We often focus on what people can personally do to determine whether they are healthy or have the potential to be healthy. Do they eat a nutritious diet, exercise enough, get their vaccinations, make good lifestyle choices and see a doctor when they’re sick?
However, some things that affect health and wellness are out of their control. These are called social determinants of health.
“We talk a lot about social determinants of health,” says Ashton Harris, lead medical social worker and case manager for Population Health at Sharp Rees-Stealy Medical Group. “Those are things like transportation, food, housing, proximity to services — all of which hugely influence somebody’s overall health and their health outcomes.”
According to the U.S. Department of Health & Human Services (HHS), social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship and age. Social determinants of health have a major impact on people’s health, well-being and quality of life, and can contribute to vast disparities and inequities. They can be grouped into five areas:
Economic stability — According to HHS, 1 in 10 people in the U.S. live in poverty, and many people can’t afford things like nutritious foods, health care and housing.
Education access and quality — Children from low-income families, with disabilities, and who routinely experience forms of social discrimination, such as racism, are more likely to struggle in school and less likely to graduate from high school, go to college or get high-paying jobs. They are also more likely to have health problems, such as heart disease, diabetes and depression.
Health care access and quality — In the U.S., approximately 1 in 10 people do not have health insurance, are less likely to have a primary care provider, and may not be able to afford the health care services and medications they need.
Neighborhood and environment — Many people live in neighborhoods with high rates of violence, unsafe air and water, and other health and safety risks. According to HHS, racial and ethnic minorities and people with low incomes are more likely to live in places with these risks.
Social and community context — People’s relationships and interactions with family, friends, co-workers and community members can have a major impact on their health and well-being. Interventions and services to help people get the support they need are crucial for improving their health and well-being.
Communities must work together to address areas of need
For example, someone who lives in a neighborhood that doesn’t have a grocery store with a variety of affordable and nutritious foods — or dependable and safe public transportation to get to one — is less likely to have adequate nutrition. Inadequate nutrition, Harris says, can then exacerbate chronic conditions, such as heart disease and diabetes, all of which can lower quality of life and life expectancy.
Simply promoting healthy choices — such as telling people they should eat nutritious foods — won’t solve the issue of the lack of access to nutritious foods or eliminate these and other health disparities. “With certain conditions, a statistic basically summed up that 80% of an individual’s health is related to their ZIP code,” Harris says.
According to the HHS, it is vital that communities work together to create social and physical environments that promote good health for all. Everyone deserves an equal opportunity to make the choices that support good health.
However, to ensure that all Americans have that opportunity, advances are needed in all areas, including:
Health care and mental health services
Language and literacy
Housing and community design
“When more people are healthy, including the most vulnerable and marginalized populations, the entire community is healthy,” Harris says.
The Sharp Health News Team are content authors who write and produce stories about Sharp HealthCare and its hospitals, clinics, medical groups and health plan.
Ashton Harris is a lead medical social worker and case manager for Population Health at Sharp Rees-Stealy Medical Group.
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