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. HealthyPeople 2020, a report card of the health of the nation, highlights the importance of addressing the social determinants of health.
According to the Centers for Disease Control (CDC), social determinants of health (SDOH) are the circumstances in which people are born, grow up, live, work and age, as well as the systems put in place to deal with illness. These circumstances are shaped by a widening set of forces – economics, social policies and policy. Examples of SDOH include income, social and economic class, occupation, employment, workplace safety, utility services, transportation, health care, food security, secure housing, education, cultural understanding, stress and other factors.
A classic example of a SDOH is income. Poor health or lack of education can impact employment opportunities, which constrain income. Low income limits access to health care and increases hardship. Hardship causes stress. Stress promotes unhealthy habits, like substance use. Stress also increases a person’s risk for obesity, diabetes, heart disease and more. Illness requires doctor visits, some diagnostic testing, certain procedures and treatments, medical equipment and supplies and prescribed medications, which all constrain income. Income spent for illnesses is income not spent on other things, like food, clothes, school supplies, paying for utilities, car loans, house mortgage or rent.
According to HealthyPeople 2020, 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.
HealthyPeople 2020 highlights that our health is also determined in part by access to social and economic opportunities; resources and supports available in our homes, neighborhoods and communities; quality of our schooling; safety of our workplaces; cleanliness of our water, food and air; and nature of our social interactions and relationships.
Experts agree that by applying what we know about SDOH, we improve individual and population health as well as advance health equity. Health equity is attainment of the highest level of quality health for all people.
The second goal of Healthy People 2010 to eliminate health disparities, includes addressing differences that occur by gender, race or ethnicity, education or income, disability, geographic location or sexual orientation.
Health care professionals are focusing on SDOH and making it a critical component for prevention programs and for proper disease management if a person already has a disease. Because some SDOH involve factors that can be modified, some health systems have moved toward value-based models that incentivize positive results in patient health outcomes rather than individual procedures and treatments. This moves us from using a disease-centered approach to a patient-centered approach when treating patients. A patient-centered approach helps providers take a holistic view of patients to enhance patient care, promote superior outcomes and drive value in health care organizations.
More information about SDOH can be found at cdc.gov and healthypeople. gov.
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