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Social Determinants of Health and Their Influence on our Health

Social Determinants of Health and Their Influence on our Health

Mon, Mar 27, 2017  -  Comments (0)  -   Posted by Kirstin Craciun

In the world of community health improvement, there has been a lot of focus on the social determinants of health lately. (This is actually probably an understatement.) But whether those conversations have translated into a greater understanding of the concept among people who don’t work in the healthcare sector is less clear.

I’ll explain what social determinants of health mean in a minute, but first let me set some context. The Northeast Ohio community is fortunate to have a wealth of top-notch healthcare providers. Hopefully we can all agree with that. Yet in stark contrast to the high quality healthcare providers in our community, in many ways our community ranks poorly on many measures of health (note our high rates of drug overdose deaths and infant mortality). How do we reconcile these two statements?

What Impacts the Risk of Premature Death?

The answer lies partially in the fact that while clinical care is an important component of health, it comprises a small slice of what is necessary for a person’s overall health. This often-cited diagram shows the impact that different factors have on the risk of premature death and highlights how social determinants of health contribute to health. Individual behavior comprises the largest slice of the pie (40%), followed by genetics (30%), and social and environmental factors (20%). Healthcare, perhaps surprising, has the smallest impact on the risk of premature death − just 10 percent of the pie.

Social Determinants of Health and Their Influence on our Health

What does this mean? Take individual behavior. The decisions we make on a daily basis, such as whether to smoke, whether to exercise and what food we will put into our bodies, are most important in determining our health. I don’t know about you, but I’ve certainly had the experience of spending the hour I had earmarked for exercise instead lounging on the couch binge watching bad t.v. while devouring a sleeve of Thin Mints (okay, box of Thin Mints, don’t judge). Snaccidents aside, to some degree we can impact our health in a positive way with healthy behaviors. And while we can’t control our genetics, the genetic code that is handed down from our ancestors still only comprises roughly one-third of what determines our health (remember this when your kids start blaming you for all their health woes). Healthcare is an even smaller component of what determines our overall health. But what about that other slice of the pie – social and environmental factors?

This is where the social determinants of health take center stage and why they have been gaining a lot of attention as a lever to help improve our collective health. Defined by Marmot, et al. as the “the structural determinants and conditions in which people are born, grow, live, work and age,” there is a growing recognition that our environment and social conditions impact how healthy we are. If a child lives in a community that is walkable, with parks and well-maintained playgrounds, that sends a message that exercise and safe play are encouraged. Alternatively, if a child lives in an unsafe neighborhood in which access to playgrounds is challenging, that child receives a different message. Both of these scenarios can have huge – and different – impacts on the child’s future well-being.

Unlike genetics, we can have a significant influence on the social determinants of health with the right strategies and policies. But first, people and key stakeholders need to buy-in to the important role that social and environmental factors play in impacting our overall health and take a look at the neighborhoods in their region that have the most to gain by improved strategies and policies. Then, the key piece is to be compelled to take action using a targeted approach.

Healthcare Providers Addressing Social Determinants of Health

Healthcare providers are increasingly doing just that and working with their public health counterparts and community partners in an effort to address some of these more “upstream” factors that can impact health. Today, there are many examples of healthcare providers locally and across the country that have taken a leadership role in the social determinants of health – examples that would have sounded foreign 10 years ago. One of the most talked about examples is ProMedica opening a grocery store in a food desert. Different, right? Not if you buy in to the importance of addressing social determinants of health.

ProMedica isn’t alone. Cincinnati Children’s Hospital doctors, after investigating the cause of a sharp increase in emergency room visits for asthma attacks, teamed up with lawyers to help address the housing problems impacting patients and their families. Makes sense, right? Get to the root cause of the problem, address it, and improve health. For parents of kids with asthma, this type of solution has a ripple effect by ensuring kids don’t miss school or daycare, parents are able to work, and healthcare costs are saved (trust me, I – like many of you − speak from experience on this one).

These efforts should be applauded. While the elephant in the room is the federal healthcare reform landscape remains uncertain, it is clear that the importance of local partnerships and the efficient use of resources will be heightened as we continue our community health improvement journey. Staying cognizant of evidence-based strategies proven to positively impact the social determinants of health and how various stakeholders can plug in to implement them will continue to be important regardless of our political landscape.

Posted in Health Equity
About the Author

Kirstin Craciun

I grew up in Canada where access to healthcare for all citizens is a core principle. I bring that thinking to the work I do as The Center for Health Affairs’ director of community outreach. I spend my days helping Northeast Ohio hospitals assess health needs in the community; develop collab...

See other articles by this author and view full bio »


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