For some years, the concept of the Social Determinants of Health has been getting more attention. My perspective is this really came into sharp relief after the Affordable Care Act passed in 2010. Millions of people joined the health insurance rolls for the first time and were able to access care. The ability to link health data with neighborhood-level data allowed public health and public policy to evaluate where their greatest needs to serve was. It also allowed for deeper partnerships between health care and community providers as many of the challenges in managing chronic conditions were outside the walls of the medical office. Data was available before that of course, for example, low air quality neighborhoods and the rise of asthma seemed to go hand in hand. Neighborhoods with few grocery stores or high-density fast food outlets tended to see increases in heart disease, obesity, and diabetes. Many efforts to improve food and physical activity environments have been going on for the past decade.
Social Determinants of Health
Healthy People 2020 has a goal of promoting environments that promote health- where you live, work, play, pray and learn influences your health.
Healthy People.Gov provide the following examples of social and physical environments.
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., the 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 environments, 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)
You can see how close we are to meeting the many objectives laid out in Healthy People 2020 here https://www.healthypeople.gov/2020/data-search/midcourse-review/topic-areas . We have a long way to go on many of them, but the needle is moving on some of them.
What Matters to You?
Now that you see some examples of how social and physical attributes of your environment can impact your health are there changes you can make to where you live and work? Can you advocate for changes in your neighborhood? Getting involved is an important step and all across the USA people are attending their local zoning meetings to discuss the health impacts of new developments and advocating for more grocery stores and green space.
Thanks for reading- Trina
(My opinions are my own)
References
Health People 2020- the source of social and physical social determinants
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
Midcourse report on Healthy People 2020
https://www.healthypeople.gov/2020/data-search/midcourse-review/topic-areas
