The social determinants of health—defined by the World Health Organization as the conditions in which people are born, grow, live, work and age—can influence as much as 80% of your health outcomes. These factors are also a driving force behind many health disparities that are occurring today worldwide.
Healthy People 2020 breaks down social determinants of health into five categories:
Source: Healthy People 2020
More specific examples include access to social and economic opportunities, resource availability, quality of education, workplace safety, healthy eating options and nature of social interactions or relationships.
In a HIMSS Innovation That Sticks podcast episode, Jeff Fritz, CEO of Revel Health, shared his take on the social determinants of health, or what he calls social barriers. These barriers, he explained, can prevent an individual from obtaining the resources they need to achieve better health outcomes and improved quality of life.
The term population health is one topic that’s closely intertwined with discussions centered on the social determinants. Population health evolved as part of the movement to study health outcomes across specific groupings of individuals, or “the community that makes up a population that the healthcare provider system views as a unit they want to make healthier,” Fritz explained. Within a specific population, the social barriers preventing individuals from improving their health or receiving care contributes to a decrease in overall health of that population as a whole. “A social barrier is something where if you removed it, you would see an increase in the health of that population.”
Thanks to the wealth of information evolving on the topic, societies are becoming more informed than ever about the existence of social barriers and how to tackle them. The three cases below, all based on U.S. population data, connect different health outcomes with specific patterns observed in challenges facing many individuals. By looking at these three different angles, we can begin to understand just how much power the social determinants of health have over our lives.
Adverse childhood events (ACEs) can have a permanent impact on the future of an individual’s social and economic stability. The original ACE study, a collaboration between the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente, looked at categories of ACEs occurring within a child’s home life.
This research focused on three different categories related to adversity:
Compared to individuals reporting no ACEs, individuals with six or more died nearly 20 years earlier.
ACEs can be connected to toxic stress, a term coined by the National Scientific Council on the Developing Child. Being subjected to toxic stress consistently as a child has been proven to negatively impact brain development—as cited by in a study conducted by The National Center for Biotechnology Information, which explored long-term effects on the structure and function of the brain.
“Compared to participants with no ACEs, those with higher ACE scores were more likely to report high school non-completion, unemployment, and living in a household below the federal poverty level,” the research states. “This evidence suggests that preventing early adversity may impact health and life opportunities that reverberate across generations. Current efforts to prevent early adversity might be more successful if they broaden public and professional understanding of the links between early adversity and poverty.”
The Behavior Risk Factor Surveillance System (BRFSS) is an ongoing surveillance system used to measure behavioral risk factors across the non-institutionalized adult population in the U.S., for individuals aged 18 years or older. Two questions related to the social determinants of health were added to the assessment, with a goal of uncovering facts about food and housing security.
The survey incorporates the perspectives of over 95,000 Americans living in 15 different states—representing approximately one-third of the U.S. population. Well over half of these respondents reported being worried or stressed in the last year about if they had enough money to eat nutritious food. The research found this lack of food security was most prevalent among African Americans (69%) and Hispanics (65%). Less than 20% of non-Hispanic whites faced this same hardship. A similar pattern of racial/ethnic disparities occurred in other parts of the BRFSS, including data collected on education levels and housing security.
A report from Feeding America estimated that one in eight Americans are food insecure; that’s 40 million people, which includes over 12 million children. Food and housing are social determinants of health that are considered actionable, the report stated. “Establishing farmers’ markets, farm stands, and community gardens in disadvantaged neighborhoods can improve food security by increasing access to affordable healthy foods at a lower cost or with alternative payment options (e.g., electronic benefits transfer discounts) and alleviating the costs associated with traveling to obtain these foods.”
A 17-year study by the CDC determined over 600,000 people in the U.S. died by suicide (from 1999 to 2015), marking historically high rates that continue to grow. Research has also stated that over half of individuals who died by suicide had no diagnosed mental health conditions.
One study looked at suicide rates occurring across urban and non-urban populations in the U.S., focusing on six different county urbanization classifications. The study confirmed a connection between less urbanized areas and higher rates of suicide. Less urbanized areas face limited access to mental healthcare, which is heightened more by a shortage of behavioral health providers in non-urban areas.
The report also stated that males were four times more likely than women to die by suicide. “All communities might benefit from strategies that enhance coping and problem-solving skills, strengthen economic support during times of financial hardship, and identify and support persons at risk for suicide,” the research report noted.
There is a wealth of resources out there that can help shed light on the impact of these determinants of health. Here are just a few recommended by the CDC which can help address and prevent future health inequities, including policy resources to help U.S. citizens activate change in their community and beyond.
If we want to build a better, healthier future for all populations, it is integral that the social determinants of health, or social barriers leading to health disparities, are addressed. Awareness needs to be amplified from the individual level to the community level and beyond to activate reform. Through collective understanding and community action, interventions can have a lasting impact on society, leading to improved health outcomes universally.
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Originally published June 18, 2019; updated November 30, 2020