The Social Determinants of Health — The Unspoken Variables of Health Inequities

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In this day and age, it’s probably not a surprise to most of us that vast differences exist between the daily lives of different racial and ethnic populations, whether through wage gaps, socioeconomic status, access to healthcare, etc.

But something that society rarely looks at is the comparison of the general health between different populations, an insight that reveals a staggering amount of structural inequity within the healthcare sector. But unbeknownst to many, the lack of adequate healthcare is only part of the problem.

Let’s Look at the Numbers — From Diabetes to COVID

Diabetes diagnoses among individuals aged 20 years or older in the United States, CDC estimates, 2014

According to recent estimates by the CDC in 2014, among individuals aged 20 years or older in the United States, 9.0% of Asian Americans, 12.8% of Hispanics, 13.2% of non-Hispanic African Americans, and 15.9% of Native Americans/Alaska Natives have been diagnosed with diabetes compared to 7.6% of Non-Hispanic Caucasians. Similar studies have been published showing ethnic and racial disparities by comparing Glycemic Control, Blood Pressure Control, Lipid Control, and many other health measures and diseases.

We can see similar outcomes with the current Coronavirus pandemic. According to the CDC’s age-adjusted COVID-19 hospitalization rates by race and ethnicity from March 13 to June 13, the Native American or Alaska Native population has a hospitalization rate of approximately 5 times that of the Non-Hispanic Caucasian population. Similarly, the African American population has a hospitalization rate of approximately 5 times that of Non-Hispanic Caucasians, and the Hispanic and Latinx population have a hospitalization rate of approximately 4 times that of Non-Hispanic Caucasians.

CDC’s COVID-19 age-adjusted hospitalization rates by race and ethnicity between March 13 to June 13

What else could be impacting the health of various populations?

The Social Determinants of Health are the key to understanding differences in the health of various racial and ethnic groups. The Social Determinants of Health are the social and economic conditions in the environments where people are born, raised, work, or spend any amount of their time. These factors have a tremendous role in an individual’s life expectancy, health status, functional limitations, and other health-related benchmarks. They fall under 6 major groups:

This determinant is made up of an individual’s income, debt, medical bills, and other factors concerning an individual’s financial security. This one is pretty straightforward; those who have more money usually have easier access to higher levels of healthcare and adequate resources.

The Neighborhood and Physical Environment determinant is made up of factors concerning the quality of housing, transportation, zip code, and safety. These factors work to raise or lower the internal and external stress on an individual, especially through a safe or unsafe environment.

The Education determinant refers to access to early childhood education, quality of education, the level of education available, language, and literacy. These factors play a large role in an individual’s career and other major life decisions and impact one’s financial security in the future.

Food is also a straightforward determinant; access to adequate food and healthy, diverse options have a predominant role of an individual’s health and susceptibility to disease.

The Healthcare determinant refers to health coverage, quality of care, access to care, and even linguistic and cultural competency between the patient and the provider. This determinant is often the most referenced when studies show disparities between the health of individuals in different ethnic or racial populations. However, it must be noted that adequate healthcare isn’t the only determinant causing inequalities between the health of racial/ethnic groups. Many societal and behavioral inequities within the other five determinants have a large effect on these disparities.

The Social and Community Context determinant is comprised of social integration, socioeconomic status, discrimination, stress, support systems, and anything else concerning the external relationships of an individual. This determinant plays a large role concerning the mental stability of individuals, as those with a stronger community and support system are more likely to avoid stress on most aspects of their health.

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So how are the 6 Social Determinants of Health related to each other?

These 6 determinants are deeply interwoven. For example, a student with an economically stable family is more likely to live in a safe environment and have access to a support system, nutritious food, educational resources, and/or proper healthcare. On the other hand, a student with a family that is not as financially stable is more likely to live in a very different physical and social environment with access to a different range of educational and medical resources.

Since the Social Determinants of Health are connected in this way, they often trap individuals in a cycle that is difficult to break out of. It is more likely for an individual who grew up without financial security to lack access to the necessary health or educational resources throughout their lifetime and be in a similar situation as their parents or guardians due to a lack of any one of the determinants, although that very well shouldn’t be the case.

How can we begin to improve these inequities among populations?

Addressing the inequities surrounding the Social Determinants of Health is essential to improving the health of our population and reducing stigmas.

Racial disparities are embedded both into society’s institutions and everyday way of thinking. In order to balance the differences in the Social Determinants of Health within our nation, we must address the discrimination on both structural and individual levels. There needs to be more education on this topic for students, adults, and professionals alike to spread the message and reduce stigma around this concept.

In particular, healthcare providers must be educated on this topic so that they can take into consideration differences within factors that contribute to the overall health of each specific individual. Understanding a patient’s life outside of their health record will likely unlock answers to many questions that healthcare providers have about the health of their patients. Without understanding the societal factors that shape where they are coming from, it is impossible to give a patient the right resources.

Photo by Anna Shvets from Pexels

TL;DR

- African Americans, Hispanics, Native Americans/Alaska Natives, and other ethnic groups are much more vulnerable to disease than non-Hispanic Caucasians.

- The Social Determinants of Health are the social and economic conditions in the environments where people are born, raised, work, or live.

- The 6 Major Determinants: Economic Stability, Neighborhood and Physical Environment, Education, Food, Healthcare, Social and Community Context.

- These factors have a tremendous role in an individual’s life expectancy, health status, functional limitations, and other health-related benchmarks.

- The 6 Determinants are interwoven; instability in one often leads to instability in another.

- To improve the health of vulnerable populations, we must educate students, adults, and most importantly, healthcare providers, on these factors.

Photo by National Cancer Institute on Unsplash

If you learned something from this article, please share it with your friends and/or family. Take the first step in educating those around us on these unspoken factors of health inequity. Be sure to connect with me and/or message me on Linkedin and leave this article a clap if you enjoyed it!

15 y/o researching neuroscience & women’s health | a collection of my thoughts | manasigajjalapurna.com