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Social Determinants and Their Effects on Quality of Life | Apr 19, 2017

Public health officials study a variety of factors related to the wellbeing of individuals and communities. While information surrounding infectious diseases and accessibility to healthcare are common talking points, especially when discussed in a more widespread forum like the news, there are other elements professionals need to consider.

Social determinants of health are the conditions in which people are born, grow, live, work and age, according to the World Health Organization. As a result, these items differ greatly from person to person and are often responsible for health inequities. It’s crucial for public health employees operating in numerous concentrations to be aware of these circumstances and their impact. The Kaiser Family Foundation lists the following as social determinants of health:

  • Economic stability
  • Neighborhood and physical environment
  • Education
  • Food
  • Community and social context
  • Health care system

Let’s take a closer look at these factors and how they influence individuals and communities alike:

Economic stability

Socioeconomic status plays a large role in people’s health. It’s common knowledge that wealthier locations tend to have healthier populations, according to OECD Observer. In these places, there’s often a lower rate of unemployment and steadier incomes. These are important factors to keep in mind regardingthe wellbeing of a community, in addition to expenses, amount of debt and level of support.

Public health officials also have to look at the type of jobs people are working and the risks associated with particular kinds of employment in regards to overall health. Work-related stress is an issue both white- and blue-collar workers experience, yet the outcomes could be dramatically different. Men and women with less economic stability often operate in environments which require mandatory or voluntary overtime. These employees are more likely to experience fatigue and sleep deprivation, which could later result in work-related accidents, according to a study published in Injury Prevention.

Overall job strain can lead to hypertension, diabetes, upper extremity musculoskeletal back problems and cardiovascular disease, the American Psychological Association reported. Work-related stress can be further complicated by the lack of on-the-job and familiar support systems. Smoking doesn’t help. Although the practice may be seen as a stress relief for workers, it can actually hurt their chances of finding work and remaining employed. According to a study published in Jama Internal Medicine, smokers were found to be younger, less educated, living in unstable housing, in poor health and more likely to possess a criminal record than non-smokers. The report looked at the length of time it took each group to locate work again and discovered non-smokers were 30 percent more to attain reemployment after a year. Smokers also have a shorter life expectancy.

Neighborhood and physical environment

In addition to looking at how well people are doing financially, public health employees have to examine the settings in which they are living and growing up. Neighborhood and physical environment – which includes things such as housing, transportation, safety, parks, playgrounds and walkability – is a crucial element related to the health of individuals and their communities.

While stable housing provides a sense of security and stability, inadequate homes can contribute to serious problems which may decrease people’s life expectancy, the Robert Wood Johnson Foundation reported. Water leaks, poor ventilation and pest infestation are just three sources of allergens which can cause respiratory conditions like asthma, according to a study published in Pediatrics. Furthermore, lack of temperature regulation – including exposure to extreme low and high temperatures – can increase mortality rates among the elderly, while those living in overcrowded environments may experience physical illnesses and psychological distress.

Outside of the home, neighborhood conditions also play a role in community health. Environments that tend to be less safe, have poor housing and experience a high rate of vandalism are also less likely to have parks and playgrounds, recreation centers or a library. Reduced access to these spaces has a negative impact on children’s weights, leading to a 20 to 60 percent higher chance of childhood obesity, according to a study published in Health Affairs. Due to poverty, violent crime and income inequality in these neighborhoods, there is less physical activity among children. Other health and behavioral outcomes that could result from living in these environments include infant mortality, depression, poor self-rated health and more.

Education

Due to its influence on both the social and economic development of individuals, education also corresponds with the overall wellbeing of communities. According to the Agency for Healthcare Research and Quality, the health benefits of instruction are seen in the following areas:

  • Individual: Skill development and access to resources
  • Community: Health-related characteristics of the environments in which people live
  • Social/cultural context: Social policies, residential segregation and unequal access to educational resources

When things like literacy, language, vocational training and higher education are lacking, disparities begin to form – especially when it comes to understanding what level of health care is necessary and navigating the system as a whole.

As a result, death rates have been steady or increasing among the least educated populations, according to a study published by the Public Library of Science. And the level of education a person receives can also make quite a difference. For example, at the age of 25, U.S. adults without a high school diploma can expect to die nine years sooner than college graduates, the U.S. Department of Health and Human Services reported. Often the educational status of the mother is the most useful predictor of health outcomes, AHRQ continued.

To aid in the development of individual skills and abilities – including cognitive qualities and personal control – as well as increase access to economic and social resources, public health officials need to closely monitor and examine the effects of education on the wellbeing of individuals and communities.

Food

This social determinant should be the most obvious link to people’s health. Without access to the nutritional products that make up the food pyramid, humans would cease to exist. Yet, there’s more to food’s impact on community health than initially meets the eye.

According to the U.S. Department of Agriculture, 13.1 million children under the age of 18 lived in households where they were unable to consistently access enough nutritious foods necessary for a healthy life in 2015. Although this is an improvement over years past, the figure is still not good enough. The first three years of a child’s life are critical to laying a strong nutritional foundation for his or her future. Not only can living in a food-insecure household result in higher hospitalization rates – due to conditions such as iron deficiency anemia, frequent stomachaches, headaches and colds – but children in these environments are at risk for developmental problems and educational struggles.

The impacts of hunger and lack of access to healthy eating options are felt throughout a person’s life. Having to repeat a grade or lower scores on math and reading tests can lead to fewer employment and advanced education options. As a result, employment selections may be even narrower, reducing a person’s ability to earn the income they need to live a healthy life. This social determinant of health can create a domino effect, much like the other factors discussed here.

Community and social context

A sense of belonging can go a long way in improving people’s health and wellbeing. While most people tend to find this comfort among friends and family, others discover social integration and engagement with a larger community.
Whatever the resource, multiple studies have found that social inclusion can improve mental health and lower mortality rates. On a larger scale, people who feel more connected may feel a stronger desire to change the conditions of others not currently living in the same state.

There is a flipside to this, however, in the form of discrimination. Bias of any kind, for any reason, can threaten access to healthcare, education and other services. As a result, the health and wellbeing of individuals and communities plagued by this exclusion may be dramatically different than others.

Health care system

Often seen as the key factor to the wellbeing of people across the country, the health care system is only a single determinant that influences public health and its outcomes. While this element must be looked at as its own entity, it also must be examined as one part of a whole.

When the Affordable Care Act was signed into law in 2010, it aimed to provide more accessible coverage for every American. By enabling people without the ability to utilize employer-offered plans to purchase insurance via state markets, the legislation’s goal was to improve overall community health by helping one individual or family at a time. Yet, there are other things that must be considered in addition to coverage, including provider availability, linguistic and cultural competency as well as quality of care.

This ensures residents who often experience barriers to healthcare – in this case, those in rural communities and those who are non-English speaking – can find a medical professional that not only fit their needs but understands patient’s’ circumstances. Without these healthcare employees, these groups of people may experience decreased life expectancy, lower quality of life and slower detection and treatment of an illness, according to Rural Health Information Hub.

When it comes to quality of care, the Centers of Medicaid and Medicare are making a push for a new model – one they feel will better serve patients of all backgrounds. Instead of reimbursing medical professionals for charging a fee for each service – which rewards employees based on the number of procedures they can complete – the CMS is aiming for value-based care. This model pays health care providers for the quality of their service as a way to reduce readmittance and unnecessary medical expenses and procedures.

Public health officials must understand social determinants of health in their actions to improve individual and community wellbeing. Earning a Master’s of Public Health from the University of Arizona can give these professionals the tools and education they need to do just that.

Sources:

http://www.who.int/social_determinants/sdh_definition/en/

http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/

http://oecdobserver.org/news/archivestory.php/aid/1241/Health_and_the_economy:_A_vital_relationship_.html

http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2513450

http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2011/rwjf70451

http://pediatrics.aappublications.org/content/107/3/505

http://content.healthaffairs.org/content/29/3/503.full.html

https://www.ahrq.gov/professionals/education/curriculum-tools/population-health/zimmerman.html

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0002181

https://www.ers.usda.gov/amber-waves/2016/november/food-insecurity-among-children-declined-to-pre-recession-levels-in-2015/

https://www.cdc.gov/nchs/data/hus/hus11.pdf

https://www.ruralhealthinfo.org/topics/healthcare-access

http://www.apa.org/pi/ses/resources/publications/work-stress-health.aspx

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html