What are social determinants of health?
According to Healthy People 2030, a government directive aimed at creating quantifiable goals to promote health and prevent disease, a social determinant of health is defined by the conditions in which people live, and those that shape their lives. Social determinants of health (SDOH) impact both quality-of-life outcomes, as well as predict risk groups in regard to attaining and maintaining overall health. They typically are grouped into five main categories: economic stability, education access and quality, health care access and quality, built environment, and social community.
Social determinants of health are also categorized within the social-ecological model (SEM), a framework used to identify and predict health risk factors at the individual, interpersonal, organizational, community and public policy levels. These categories are important for understanding both the origin and level of impact of a SDOH, as intervention and prevention methods are most effective when addressed at the appropriate level. For example, food insecurity is a major health determinant. But many factors inhibit nutritious eating, such as living in a food desert (community level), lack of nutrition education (organizational and individual levels) and neighborhood poverty (while a community level issue, this can be traced back to public policy and other factors).
Economic stability among San Diego communities:
Social determinants can be seen at a local level. For example, the top 5% of income earners in San Diego possess as much wealth as the bottom 60% of income earners combined. This exposes a significant wealth gap, as income is concentrated among the richest 5%. Check out this website for more findings and statistics about economic disparities in San Diego. Economic inequality is a main social determinant of health, as money buys services and goods that promote health; for example, gym memberships, healthy organic foods, adequate groceries, better (more comprehensive) health insurance and sports team memberships. Not to mention wealth typically correlates to safer communities and better education access, due to increased funding. As a result, many SDOH tie into one another, creating a compounded impact on one’s overall health.
Education access among San Diego communities:
According to a 2018 San Diego economy report, those in the Hispanic community were found to be over 3 times less likely to attain a bachelor’s degree than whites. In addition, Hispanics were almost 3 times more likely to receive less than a high school degree, in comparison to whites. Disparities as such usually result from a variety of reasons: increased poverty rates among minority populations, racism and historically racist policies, lack of access to learning opportunities (such as tutoring, SAT prep classes, quality schools and teachers, etc).
The impact of unequal education access goes beyond the attainment of a degree. It often dictates the type of career one enters into, which impacts wealth and lifestyle, and ultimately one’s quality of life. And especially among minorities that are continually impacted by disproportionate education access, this lack perpetuates the cycle of poverty by limiting access to the very opportunities that correlate to increased income rates.
Compounded inequality:
As mentioned, social determinants of health often intertwine, creating compounded inequality among San Diego communities. Acknowledging SDOH allows public health experts to identify high risk groups, as well as determine intervention and prevention methods that adequately address each community’s needs. However, social determinants of health are complex, intricate topics that expose generations of compiled inequality among often marginalized groups of people. Therefore, when a community’s health is compromised, we must look beyond what is in each individual’s direct control and into the social framework surrounding them to identify the root of the issue.
By: Cassie Guiley