Let’s talk about a really important foundational concept, that is only touched once or twice in medical school but is the basis of public health – Social Determinants of Health.
Access to healthcare and healthcare itself only determines approximately 10-20% of an individual’s health, but there are more important factors. In most cases, your socioeconomic status determines where you live, where you work and the resources that you have access to. These factors include, but are not limited to, housing, food access, childhood development, neighborhood safety, social network, education, etc.
To put this into perspective I want to share some findings from a couple articles: Childhood obesity is higher in ethnic minorities and a study looked at how this may be due to limited access to healthy, affordable options – due to the prevalence of urban, corner stores that sell energy-dense, low-nutritive foods and beverages. It found that purchases made in corner stores contribute significantly to energy intake among urban school children
Another study looked into neighborhood deprivation ( unemployment, financial problems, neighborhood issues, etc) and health outcomes (depression, general health, waist/hip ratio). Results found that neighborhood deprivation was associated with all three health outcomes over and above the individual’s socioeconomic status.
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So knowing all of this, what does it mean? What can we do as healthcare professionals with this information? It means we create programs in communities that lack resources – programs that cater to these social determinants. If a patient is not attending an appointment for a third time in a row – maybe look into their transportation? See if there is something going on at home or in their neighborhood. Our next post will further look into how! For now, I challenge you to think of how you can address SDOH in your respective field so we can transform healthcare together.
Sources
- Borradaile KE, Sherman S, Vander Veur SS, et al. Snacking in children: The role of urban corner stores. Pediatrics. 2009;124(5):1293-1298. doi: 10.1542/peds.2009-0964.
- Stafford M, Marmot M. Neighbourhood deprivation and health: Does it affect us all equally? Int J Epidemiol. 2003;32(3):357-366. Accessed 5/18/2020. doi: 10.1093/ije/dyg084.
A Kritical Look 