Dr. Neil Maniar, professor of practice and Director of the Master of Public Health program at Northeastern, explores the many social determinants of health and their significance in the field of public health.
What are the Social Determinants of Health?
Where we live, work, learn, and play all have a profound influence on our health. This idea is fundamental to the concept of social determinants of health. Over the past three decades, the field of public health has experienced a dramatic shift towards a greater understanding and appreciation for the role of social determinants across a broad range of health outcomes.
So what exactly are social determinants? They include, but are not limited to:
- Access to healthy and affordable nutrition
- Access to safe and stable housing
- Neighborhood safety
- Access to healthcare
- Environmental exposures
- Economic conditions
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Your Zip Code Is as Important as Your Genetic Code
Recent studies have highlighted the role of neighborhood-level factors in shaping health outcomes. In many cases, these external factors were even more influential in driving health outcomes than one’s own genetic makeup. Studies of communities across the country have found that disparities across a range of health, social, and economic outcomes are concentrated within well-defined geographic boundaries. For example, the Boston neighborhoods of Roxbury, Dorchester, and Mattapan have consistently higher rates of cancer, cardiovascular disease, violence, and unemployment compared to more affluent neighborhoods such as Back Bay or Beacon Hill. Similar trends are observed in cities and towns throughout the country.
Digging Into the Data
A growing body of research underscores the association of social determinants with many different health outcomes. For example, according to a Department of Health and Human Services study, individuals who are college graduates have a significantly longer life expectancy compared to individuals with less than a high school education—60 years versus 47 years. Similarly, infant mortality rates, which are often seen as a key indicator of the overall health of a population, are twice as high among mothers with less than a high school education compared to mothers who are college graduates.
As one might expect, determinants such as education and family income influence many different facets of health. According to the 2012 National Survey of Children’s Health, over 30 percent of children in families who were below the federal poverty level reported poor health status compared to less than seven percent of children in families who were at least 400 percent above the federal poverty level. The pathways that connect socioeconomic status to health can include access to care, health literacy, levels of social support, and exposure to environmental factors.
How Can Public Health Professionals Address Social Determinants of Health?
The realm of social determinants of health is vast in scope; however, there are a number of evidence-based strategies that can effectively and sustainably mitigate the impact of social determinants. One of the most important strategies is to raise awareness of the importance of social determinants when addressing health outcomes. Developing a greater understanding of the context within which health occurs can enable public health and healthcare professionals to more effectively improve the health of individuals, families, and communities.
In addition, it is also important to look upstream when developing prevention programs that address social determinants of health. Many of the determinants described above can not only impact health at multiple points across the lifespan but also lead to changes in health many years after the initial exposure.
Additional strategies to address social determinants include voucher programs to facilitate access to health and affordable nutrition, programs that help individuals complete their education and pursue higher education, community health worker programs to facilitate access to high-quality health care, and programs that connect individuals and family to safe, stable and affordable housing.
Social Determinants and the Future of Public Health
The role of social determinants within the field of public health will continue to grow as our understanding of various determinants and their impact continues to evolve. The integration of digital health, health informatics, and other rapidly developing technologies offer exciting opportunities to tackle social determinants and improve the health of individuals, families, and communities in innovative and long-lasting ways. Addressing social determinants of health also offer public health professionals the opportunity to solve some of our most vexing public health problems including the persistent disparities in health outcomes, the epidemic of violence and the opioid epidemic.