Social determinants of health are the conditions in which people are born, grow, live, work and age that shape health. They include factors like socioeconomic status, education, neighborhood and physical environment, employment, and social support networks, as well as access to health care. Addressing social determinants of health is important for improving health and reducing longstanding disparities in health and health care.
There are a growing number of initiatives to address social determinants of health within and outside of the health care system. Outside of the health care system, initiatives seek to shape policies and practices in non-health sectors in ways that promote health and health equity. Within the health care system, there are multi-payer federal and state initiatives as well as private sector initiatives focused on addressing social needs.
The World Health Organisation suggests that healthier environments could prevent almost one quarter of the global burden of disease and the COVID-19 pandemic is a further reminder of the delicate relationship between people and our planet. Clean air, stable climate, adequate water, sanitation and hygiene, safe use of chemicals, protection from radiation, healthy and safe workplaces, sound agricultural practices, health-supportive cities and built environments, and a preserved nature are all prerequisites for good health.
Scientists suspect many of the things we are exposed to in our environment are related to health problems like cancer, asthma or Parkinson’s disease. But it’s not just what we’re exposed to that matters: A potential environmental impact on health can lead to a cascade of biological events in the body that alters the way it works – but these changes can be bad or good, and are highly individual depending on genes and circumstances.
For example, obesity is related to genes and exposure to certain chemicals. But how much activity a person gets every day can be a bigger predictor of whether or not someone is a healthy weight. That means availability of parks, affordable healthy food and even sidewalks are important environmental factors in helping people keep their BMI in check.
While exposure to certain substances is bad, an environmental health problem also can be related to not getting enough of something good. Autism has been linked to pesticides but research suggests not getting the recommended amount of folic acid during pregnancy could contribute to it, too. Folic acid is recommended for all women planning a pregnancy to prevent neural tube defects in babies but it can also protect against autism.
Another factor to consider is economics, which plays a crucial role in the way disease, illness and disability plays out over the long-term. Autism, for example, has been associated with an immune response in mothers that scientists hope someday could help identify the condition before a baby is even born. Very early intervention could help children with autism – but only if their families have access to quality health care. Also, people who are socially and economically disadvantaged carry a heavier burden of disease.
Hence, a large number of studies have demonstrated a strong link between better education and better health, and education has been shown to be a reliable predictor of lower mortality rates. The probability of being in good or very good health is higher for people with university or post-secondary education.
Countries with some sort of social protection (i.e. a safety net or social security system) show improved health and economic outcomes in circumstances where people become unable to earn a living.
The physical environment where communities live has a great impact on the health of the residents. Factors which have a negative impact on health include overcrowding, damp living conditions and crime (in particular fear of crime). The WHO concludes that health outcomes “are largely determined by the accessibility to adequate housing and to healthy and safe urban environments and by transport conditions.”
It is therefore essential that healthcare workers dedicated to improving health increase their effectiveness by addressing the “upstream” causes of health in the community and by engaging in ways to change the broad policies, systems and environments that shape the social and economic conditions that, in turn, so strongly influence health. To be most effective at improving the health of families and communities and to ensure the greatest impact for the investment of resources, health professionals need to expand their repertoire of skills and activities both with their individual patients and in the policy arena.
Okeke writes from the Centre for Social Justice (CSJ) Nigeria
