Social determinants of health, part 2

This post is the second in a three-part series on social determinants of health, collaboratively written by KHA staff members Lisa Gary, Khadija Jahfiya and Jasmine Hall Ratliff. A new post will be published each Tuesday in June.

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Most times, when people think about what makes a healthy community, they think primarily about access to a good doctor or a hospital. They may also think about the presence of parks or playgrounds or the quality of the air. These are definitely important, but probably more important to one’s health are aspects of their community that don’t immediately come to mind. This can include the type and quality of housing, access to public transit or the income a person earns. When we look across neighborhoods and communities, these social determinants contribute to what make easier or harder for a person to be healthy.

While access to quality health care is important, more crucial to one’s health is where they live, what schools they attend, the level of income they earn and what healthy behaviors they adapt. Even then, healthy behaviors and healthy choices are often limited by one’s environment. If healthy food is not accessible within walking distance then it may be difficult for an individual to maintain a nutritious diet.

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Social determinants of health, defined by the Centers for Disease Control, are the “conditions where people live, learn, work and play” that can have an impact on their health risks and outcomes. Factors such as quality of housing, income and education levels and neighborhood safety will impact the health and wellness of an individual. In fact, as you can see in this graphic, social determinants are collectively more integral to an individual’s health than access to health care.

Where one lives, and thus the ability to live a healthy life, also predicts one’s lifespan. Over the past 10 years, Virginia Commonwealth University created maps of metropolitan and rural areas across the country to demonstrate how the difference of environments between just a few miles can have a marked impact on one’s lifespan.

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For example, in New York City, a densely populated yet geographically small region, there is a 9-year life expectancy difference between only 6 subway train stops. A child growing up in the Bronx (Concourse, Highbridge stop) will be more likely to be in a single parent household, more likely to live in poverty, less likely to graduate from high school and more likely to live in a poor quality home than a child growing up in lower Manhattan of New York City. As a result, if social determinants do not improve, that child will likely live to only see his or her 77th birthday. Compare this child to the child in lower Manhattan who will more likely be in a 2-parent household, graduate high school and live in better quality housing in a neighborhood with less violence and thus live to be 85.

Think about where you grew up. Was your neighborhood safe from violent activity? Was there a bus or transit stop close enough to walk and was run efficiently? Was there a grocery store nearby? How well did your school rank among others in the city or state? These all played a role in your current health status, in addition to and perhaps more so than how often you visited a doctor. In too many communities the inequities of these social determinants are leading to disparities in health outcomes. Good health is much more than good health care, it starts with where people live.