9.1 Social determinants of health and health disparities

Social determinants of health shape our well-being more than medical care alone. These factors, like education, income, and housing, create complex health effects over our lives. Understanding them is key to improving public health.

Health disparities arise from these social factors, leading to unfair differences in outcomes between groups. Income, race, and location all play a role. Addressing these root causes is crucial for creating a more equitable healthcare system.

Social Determinants of Health

Definition and Scope

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• Social determinants of health encompass conditions shaping health outcomes throughout life
• Include factors such as education, income, employment, housing, and neighborhood conditions
• Influence individual and community health outcomes more significantly than medical care or behaviors
• World Health Organization recognizes social determinants as key drivers of health inequities
• Understanding social determinants proves crucial for developing effective public health interventions
• Social determinants interact in complex ways, creating cumulative health effects over lifetimes
• Addressing social determinants leads to substantial and sustainable improvements in population health

Impact on Health Outcomes

• Social determinants significantly influence individual and community health outcomes
• Create complex interactions often resulting in cumulative health effects over lifetimes
• Addressing social determinants leads to more substantial health improvements than medical interventions alone
• Research demonstrates the effectiveness of targeting social determinants for population health
• Examples of health impacts include:
  • Lower education levels correlate with higher rates of chronic diseases (diabetes, heart disease)
  • Poor housing conditions contribute to respiratory issues (asthma, allergies)
  • Limited access to healthy food options in neighborhoods increases obesity rates

Health Disparities by Socioeconomic Factors

Income and Education

• Health disparities manifest as preventable differences in health outcomes between population groups
• Income and education levels strongly correlate with health outcomes
• Lower socioeconomic status associates with poorer health outcomes
• Examples of disparities:
  • Lower income groups experience higher rates of cardiovascular disease
  • Individuals with less education show increased likelihood of smoking

Race, Ethnicity, and Geography

• Racial and ethnic minorities often experience higher rates of chronic diseases and lower life expectancy
• Geographic location impacts health outcomes due to differences in healthcare access and environmental conditions
• Urban vs. rural residence influences health through varied economic opportunities and healthcare availability
• Examples include:
  • African Americans have higher rates of hypertension compared to white Americans
  • Rural residents face longer travel times to reach medical facilities

Employment and Gender

• Employment status and occupation type influence health through job-related factors
• Gender disparities persist in health outcomes, including life expectancy and disease prevalence
• Immigration status affects health outcomes due to barriers in accessing healthcare services
• Examples of disparities:
  • Manual laborers face higher risks of occupational injuries
  • Women generally have longer life expectancies but higher rates of certain chronic conditions (osteoporosis)

Social Determinants and Health Inequities

Fundamental Causes and Accumulation of Risk

• Health inequities represent systematic, avoidable, and unjust differences in health status
• "Fundamental causes" theory posits social conditions as root causes of health inequities
• Social determinants create a "chain of risk" where disadvantages accumulate over time
• Intersectionality in social determinants often amplifies health inequities
• Examples include:
  • Lack of education limits job opportunities, leading to lower income and reduced access to healthcare
  • Living in a food desert contributes to poor nutrition, increasing risk of obesity and related health issues

Structural Factors and Long-term Effects

• Structural racism and discrimination contribute to persistent health inequities
• "Weathering hypothesis" suggests chronic exposure to disadvantage leads to accelerated aging
• Policies addressing social determinants effectively reduce health inequities
• Examples of long-term effects:
  • Childhood poverty increases risk of adult cardiovascular disease
  • Chronic stress from discrimination contributes to higher rates of hypertension in minority populations

Healthcare Systems and Social Determinants

Expanding Healthcare's Role

• Healthcare systems increasingly recognize responsibility to address social determinants
• "Population health management" involves proactive approaches to improving community health outcomes
• Screening for social needs in clinical settings identifies non-medical factors affecting patient health
• Examples of expanded roles:
  • Hospitals partnering with local food banks to address food insecurity
  • Healthcare providers prescribing exercise programs in community centers

Integration and Partnerships

• Community health workers bridge gaps between healthcare systems and community resources
• Partnerships between healthcare and community-based organizations create comprehensive approaches
• Value-based care models incentivize investment in addressing social determinants
• Data sharing enhances ability to identify and address social determinants effectively
• Examples of integration:
  • Electronic health records incorporating social determinant data
  • Health systems collaborating with housing agencies to provide stable housing for high-risk patients

Challenges and Opportunities

• Funding limitations constrain efforts to address social determinants through healthcare systems
• Fragmented services create obstacles in providing comprehensive care
• Long-term commitment required to see results in addressing social determinants
• Opportunities for improvement include:
  • Developing standardized screening tools for social determinants across healthcare settings
  • Creating policy frameworks that support cross-sector collaboration in addressing health inequities