“Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” -Martin Luther King When we think of health, it is easy to go straight to physical health: how our bodies feel and function. In recent years greater attention has been paid to our mental health: how our minds feel and function. But what about social health, or how our communities feel and function. We often overlook how a person’s social position affects their chances of living a healthy and productive life. It is wholly inadequate to talk about building healthy communities and citizens without talking about the social determinants of health. And despite the fact that the U.S. spends more than any other nation on medical care, when it comes to key measures of health the U.S. is at the bottom of the list (Bravemen et. al., 2014). So why is the health status of Americans not keeping up with citizens of other developed nations? Understanding the social determinants of health is key to understanding the answer to this important and urgent question. The Center for Disease Control (CDC), names the following as the 5 key social determinants of health: 1. Economic Stability 2. Education 3. Social and Community Context 4. Health and Health Care 5. Neighborhood and Built Environment The following is an overview of each of the key social determinants identified by the CDC. The purpose of the overview is to introduce the topics and to provide examples of how these shortcomings play out in daily life. Economic Stability: Compared to other countries of similar wealth, the U.S. has the highest income inequality (Peterson Center on Healthcare). People with lower income are not only less likely to be able to afford routine healthcare, but typically have stressful and physically demanding jobs that can lead to health issues down the road (Inequality.org). Income inequality also affects the health of our country. For instance, “a study published in the Journal of the American College of Cardiology in 2019 found that the higher the level of income inequality, the higher the rate of cardiovascular-related deaths and hospitalizations” (Inequality.org). Social determinants exacerbate underlying conditions, worsen illnesses for the genetically vulnerable, and otherwise complicate and erode health status. When known risk factors are present in people with economic disadvantages, quality of life suffers greatly. Education: Education levels are also a major determinant of health and arguably the easiest to change. An educational environment that allows students to grow not only academically, but emotionally can be life changing for their health as an adult. According to a 2010 National Center for Health Statistics report, “U.S. women age 25 in 2005 who never finished high school could expect to live another 52 years, compared to another 57.3 years for women who completed high school… Men who never finished high school could expect to live another 46.2 years, compared with 51.5 for those with high school diplomas” (McGill, 2016). This shortened life span is not the whole story, for it is very likely that there is a slow reduction in years of useful life as health status deteriorates unchecked. Social and Community Context: Social and community context is an exhaustive topic. The Office of Disease Prevention and Health Promotion lists the following: civic participation, discrimination, incarceration, and social cohesion. I think the most relevant now is discrimination. We are seeing how social positions affect health outcomes right now, as Black and Brown communities are disproportionately affected by the Covid-19 pandemic. Health and Health Care: Of course, access to health care and primary services is a major social determinant of health. Likewise, lack of health literacy can prevent people from knowing how and where to find services. According to the World Health Organization (WHO) health literacy is defined as “the personal characteristics and social resources needed for individuals and communities to access, understand, appraise and use information and services to make decisions about health’” (Rowlands et. al., 2015). In addition to health literacy, lack of health insurance is also an issue, “although coverage in the U.S. has increased recently with implementation of the Affordable Care Act, the U.S. still has a lower rate of health coverage (91.2% in 2016) than any comparable country, all of which cover 100% of their citizens” (Peterson Center on Health Care). Without a foundational understanding of health and health care, deterioration of health status is exacerbated by the simple fact that many don’t know what they don't know. We have it in our power to right this wrong just as other countries have wisely elected to do. Neighborhood and Built Environment: Where we live can have a major effect on our health and well-being. Many neighborhoods across the U.S. have high rates of crime and violence or are in areas with poor water and/or air quality. Food deserts can also be a factor here. A food desert refers to an area where fresh, healthy, affordable food is limited. To elaborate, “according to a report prepared for Congress by the Economic Research Service of the US Department of Agriculture, about 2.3 million people (or 2.2 percent of all US households) live more than one mile away from a supermarket and do not own a car” (Food Empowerment Project, 2020). Without a safe, healthy environment, long-term and detrimental health risks increase. While many of us pay little attention to societal advantages that accrue to our benefit, this privilege comes with the obligation to create the conditions within which all of us are welcomed. This is true not only because it is the right thing to do, but because to do otherwise is to contribute to our own diminishment as a society. Our healthcare system will lag behind the developed world for as long as we turn away from those on the margins of our communities. References:
Bridget DonnellyBridget Donnelly is an MSW Candidate at the University of Michigan. She graduated from DePauw University in 2019 with a Bachelor of Arts in Peace and Conflict Studies. Bridget serves as a wellness coach at U-M’s Wolverine Wellness where she works with students one-on-one to help them achieve their wellness goals and discuss topics such as stress, sleep, anxiety, depression, body image, etc. She also works as an MSW intern at a community non-profit organization in Ann Arbor, MI called Girls Group. The organization is aimed at empowering first generation college students to achieve academic, emotional, and economic self-sufficiency. Bridget is also passionate about holistic wellness, prison reform, and crisis intervention.
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