A goal that all Americans can agree on is getting the best and most accessible healthcare for all Americans. While we work towards this goal as a country, it’s important to understand that although not often talked about, social determinants have a large impact on the health, therefore the healthcare that Americans receive.
The social determinants of health (SDH) are the non-medical factors that influence health outcomes. As quoted by the World Health Organization (WHO): they are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
The SDH have an important influence on health inequities - the unfair and avoidable differences in health status seen between countries. In countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.
The following list provides examples of the social determinants of health, which can influence health equity in positive and negative ways:
Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.
Addressing SDH appropriately is fundamental for improving health and reducing longstanding inequities in health, which requires action by all sectors and civil society.
Over 11 percent of adults prescribed medication in the last year said they didn’t take it as prescribed in order to save money, and that percentage jumped to more than 33 percent for those were were uninsured. Not taking a medication as prescribed may include taking less, skipping doses, or prolonging a refill. Additionally, 1 in 7 people with diabetes ration medications because of cost—a potentially fatal decision for those who depend on insulin.
Even something as simple as eating enough fruits and vegetables can be affected by SDOH. Nearly 30 million people live in areas with limited access to supermarkets, with those in rural areas traveling upwards of 20 miles to get to a full-service supermarket. A lack of reliable transportation could make it nearly impossible to get to a larger store with more access to affordable, fresh foods.
Where someone lives also affects their access to primary care and emergency services. A study of nearly 4,000 census tracts in Chicago, Los Angeles, and New York City found that black-majority neighborhoods were more likely to have less geographic access to trauma care than other races or ethnic groups.
Additionally, social determinants of health in childhood can impact a person’s health into adulthood. A recent study found an association between childhood history of both parental incarceration and juvenile justice involvement and mental health as a young adult.
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Effective date: August 25, 2020
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