The playing field isn’t level.
Circumstances — often beyond your control — influence your survival odds from the time you’re born. Neighborhood, income, education, discrimination and environment all affect disease risk, medical care quality and ultimately, your lifelong health. Factors like these, known as social determinants of health, have a significant impact on your well-being and lifespan. Healthy People 2020, a Department of Health and Human Services initiative which set the latest 10-year, evidence-based national health objectives, has included “create social and physical environments that promote good health for all” as an overarching goal. See how key social determinants interact to improve or worsen your health.
ZIP Code
While it’s a complex relationship, affecting some households more than others, ZIP code is one of the top three social health determinants, according to Dr. Pedro Greer Jr., chairman of the department of medicine, family medicine and community health at the Herbert Wertheim College of Medicine at Florida International University. Where you live affects everything from community resources to whether you can exercise safely to your daily access to healthy food.
Education
Obtaining more education reduces your risk of dying within the next five years by 1.8 percent, according to the National Bureau of Economic Research. By graduating from high school and spending some time in college, your risk of heart disease drops by more than 2 percent; and for diabetes, by slightly more than 1 percent. Social determinants combine to influence health along multiple dimensions. Income affects neighborhood, which affects school choice, which affects education. In addition, children in nurturing, engaged families get more support for completing classwork and homework and making school a priority. Learning about health, diet and exercise are all part of a comprehensive education.
Family
Strong family bonds are a protective health factor, points out Luther Brewster, an assistant professor of medicine and society at Florida International University. In the U.S., ethnic groups whose cultures emphasize family ties show better mental health than the rest of the population, social scientists have found. Supportive parents and members of the extended family — grandparents, aunts, uncles and cousins — help children feel loved, confident, safe and secure.
Race
For some medical conditions, race and ethnicity can affect how patients will fare. Various studies on diabetes have pinpointed worse results in blood-sugar control, blood pressure and cholesterol levels, and medical complications when comparing African-Americans, Latinos, Asian-Americans and others to white patients. While breast cancer tends to be more biologically aggressive in African-American women than white women, other factors also contribute to higher mortality rates in the former group. Barriers such as fewer referrals for cancer screening in certain geographic locations, or among women with lower incomes or inadequate insurance, also play a role, according to a study published in September 2014 in the Annals of Translational Medicine & Epidemiology.
Marital status
People with cancer get a survival boost by being married. In a study of racial and ethnic disparities in cancer survival, for men with colon cancer, marital status mattered as much as the cancer’s stage in reducing survival disparities, according to data from nearly 900,000 patients in the California Cancer Registry. Overall, for patients with breast, prostate, colon or lung cancer, marital status accounted for up to 18 percent of survival disparities among men, and up to 14 percent among women, in the study published online on Oct. 16 in the Journal of Clinical Oncology. An earlier study on thyroid cancer found worse survival rates among widowed and divorced patients compared to their married counterparts.
Insurance
Health insurance boosts access to health care. That’s why Americans have signed up for Affordable Care Act coverage in record numbers, with nearly 2.3 million people seeking coverage in the first month of the 2018 open enrollment period. In addition, Medicare and Medicaid help ensure that older adults or those with lower incomes have continued access to health care. The Children’s Health Insurance Program provides low-cost coverage to families who don’t otherwise qualify for assistance. With CHIP, kids receive routine checkups, vaccinations, prescriptions, dental and vision care, hospital care and emergency services that higher-income families may take for granted.
Childhood care
Early childhood care shapes the trajectory for lifelong health. Failure to thrive means not gaining weight or height on par with other young children. If the underlying causes are not addressed, these kids may develop learning disorders, impaired language and motor skills and persistent growth failure. That’s why many hospitals and health centers offer outpatient services for families and children who are failing to thrive. For instance, the Grow Clinic for Children at Boston Medical Center provides an array of medical, nutritional, developmental and social services to help these kids get as healthy as possible.
Income
Economic and physical well-being are strongly connected. “The greater one’s income, the lower one’s likelihood of disease and premature death,” is the stark introduction to an April 2015 Urban Institute report. It’s not just about yearly earnings but also accumulated wealth, the authors found. Household income affects health on every step of the ladder. So middle-class Americans are healthier than those living in or near poverty, but upper-class Americans are healthier still, the report shows. Even among the wealthy, billionaires will likely enjoy better health than mere millionaires.
Housing
Unstable housing is bad for your health. It’s hard to connect to a medical practice or community resources when you’re scrambling to find a secure place to live. Helping people afford a home makes a healthy difference. For example, receiving housing assistance from the U.S. Department of Housing and Urban Development is linked to improved access to health care, according to a study published on June 17 in the journal Health Affairs. Researchers found HUD housing assistance was associated with lower rates of uninsurance and with less unmet medical need.
Discrimination
“Health disparities negatively impact people of color in spite of annual income and education level,” says Alfiee Breland-Noble, an associate professor of psychiatry at Georgetown University Medical Center. Education and money don’t protect people from experiencing racism and discrimination, she notes. Mental health is an area where bias and stigma keep people from seeking care. Breland-Noble, a child psychologist, heads the African American Knowledge Optimized for Mindfully-Healthy Adolescents Project at Georgetown. The AAKOMA Project seeks to improve engagement by African-American adolescents and their families in psychological and psychiatric treatment for depression and related disorders.
Environment
Moldy homes in smoggy cities with lead-contaminated water supplies: Environmental hazards clearly affect children’s health. Asthma and allergies worsen as kids breathe in dusty, dirty air. Drinking water from lead pipes and living between lead-painted walls exposes kids to the risk of impaired brain development. Adults in high-lead settings are at increased risk for high blood pressure and kidney disease, according to the World Health Organization.
Research inclusion
Being left out of clinical trials, such as those with mostly male or white participants, means medical breakthroughs don’t necessarily apply to all. Certain diseases, treatments and drug side effects impact people differently by sex, race and ethnic background. Resetting the scales and finding new, evidence-based ways to reduce disparities starts with more diversity among health researchers, Breland-Noble says. Equal funding is an issue, she adds: “The innovative ideas of diverse researchers must be supported — especially financially — as a first step.”
Health technologies
Emerging health care technologies like precision medicine have the potential to dramatically improve health for patients with access to them. However, technological progress against disease may actually widen survival disparities between patients of high versus low socioeconomic status, suggests a commentary also appearing in Health Affairs. On a smaller scale, the ability to afford personal health technologies, such as telehealth apps or wearable devices to monitor vital signs, physical activity, diet and sleep, may also increase the divide between health “haves” and “have-nots.”
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13 Ways Social Determinants Affect Health originally appeared on usnews.com
