What are the social determinants of health?

The social determinants of health are the conditions, in which children, youth, and families are born, grow up, live and work, as well as the quality and accessibility to health care (Shern, Steverman, Ahmed, & Shea, 2011). Where you live can be a significant indicator of how well you live as well as how long you live. Such non-medical factors influence health and well-being, including health-related knowledge, attitudes, beliefs, or behaviors.2 Socioeconomic inequalities in health have been widening for decades. In the United States the data consistently show that people living in poverty, and particularly those who are minorities, bear a disproportionate burden of exposure to unhealthy environments and are at greater risk for mental and behavioral health-related conditions.3 In addition to health literacy, gender, education, sexual orientation and geography; culture, acculturation, language, race, ethnicity, socioeconomic status, and social exclusion significantly influence overall health status as well.4 These factors tend to be interrelated and contribute to disparities among, as well as within, groups.

Why address the social determinants of health?

Creating a framework that incorporates the social determinants of health can provide a more complete picture of why people become ill initially, and, moreover, what it will take to restore their health. It recognizes the value of equity and social justice as essential to staying healthy and accessing quality health care. Policy changes to alleviate the social determinants of health, such as poverty, racism, violence and access to resources, can have a far reaching impact on improving the health of a community, state or county. Addressing only the symptoms of illness and ignoring its root cause will not improve population health.

• Approximately 3.5. million individuals are homeless in America.5

• In the U.S., 44 million people are living in poverty and 41.3 million are using food stamps.6

• Children living in poverty are seven times more likely to have poor health than children in higher income households. 7

• With a prison population of 2.3 million, we now have the highest rate of incarceration in the world.8

• Approximately 30 percent of LGBT youth report having been physically abused by family members because of their sexual orientation, gender identity or expression.9

• LGB individuals had a 1.5 times higher risk for depression and anxiety disorders over a period of 12 months or a lifetime than heterosexual individuals.10

• African Americans are 30 percent more likely to report having serious psychological distress than non-Hispanic Whites.11

• In 2007, Hispanics were 3 times more likely to be uninsured than non-Hispanics.12

• American Indians and Alaska Natives have an infant death rate 40 percent higher than the rate for Caucasians.13

• American Indian/Alaska Native adults were 2.3 times as likely as white adults to be diagnosed with diabetes.14

• In 2006, adults with less than a high school degree were 50 percent less likely to have visited a doctor in the past 12 months compared to those with a bachelor’s degree.15

• Only 33 percent of disadvantaged fourth-graders are proficient readers at grade level.16
• Poor Mexican-American children ages 2 to 9 have the highest proportion of untreated decayed teeth (70.5 percent), followed by poor non-Hispanic black children (67.4 percent).17

Key Messages for Everyone

• Social determinants of health are the primary determinants regarding whether individuals stay healthy or become ill

• The larger the gap in health disparities, the more the overall health status of entire populations is reduced

• The larger the difference in health status between the healthiest and least healthy in a community the lower the overall health status of the population.

• Assess the community with the community using a community-based participatory approach (community engagement)

• Significant health inequalities persist among and within minority groups

Tips for Communities

1. Raise awareness of the importance of the social determinants of health and their impact on individuals and communities.

2. Pursue policies to assure that healthful food, safe housing and living wages are available to everyone in the community.

3. Support community activities to build social networks among individuals who represent differing racial or ethnic groups