The quality of care patients receive in a clinic or hospital is obviously vital to their health. But according to some estimates, other "modifiable" factors play a much larger role when it comes to health outcomes. In fact, one study attributes only 16% of health outcomes to clinical care—the remaining 84% can be attributed to socioeconomic factors, health behaviors, and physical environment. This may be part of the reason why health markers such as life expectancy continue to decrease in the United States even as the average per-person spending on healthcare is increasing. How much money we put toward healthcare isn’t all that relevant if the main determinants of health aren't being adequately addressed. For example, poor health outcomes in America are often attributable to behaviors like unhealthy eating habits and a sedentary lifestyle. We can see this play out in the fact that more than 40% of Americans are obese and nearly half have hypertension, according to CDC statistics. It’s no surprise, then, that the three leading causes of disease-related death in the United States are heart disease, cancer, and chronic lower respiratory diseases—all of which can be affected by modifiable lifestyle factors. Experts call these environmental, social, and cultural factors the social determinants of health (SDOH). According to the US Department of Health and Human Services (HSS), examples include: Housing security and safety Reliability of transportation Being subjected to racial discrimination and/or violence The state of job opportunities Access to nutritious food and opportunities for physical activity Levels of air and water pollution And others HHS points out, for example, that those who don’t have access to grocery stores with healthy food options will have less nutritious diets, which in turn “raises their risk of health conditions like heart disease, diabetes, and obesity—and even lowers life expectancy relative to people who do have access to healthy foods.” SDOH can be grouped into five categories: Environment, education, access to healthcare, social and community context, and socioeconomic status. Here’s a rundown of the categories and how they impact health. Environment As HHS experts point out, some people live in neighborhoods with high rates of violence, while others may live in areas with polluted water or air. Some live in areas where both are present. Racial and ethnic minorities, as well as those with lower incomes, are more likely to live in environments with these kinds of health risks. One prominent example of the environment as an SDOH is the water crisis in Flint, MI, where 42% of the population lives in poverty and 54% of the population is Black. Exposure to lead-contaminated water in that city led to the deaths of 12 people and doubled the number of children with lead toxicity. Your living situation can also impact your health through factors like whether or not you live in an area with access to nutritious food, opportunities for physical exercise, and reliable transportation to help you get around. Research has shown that having better access to supermarkets is associated with lower rates of obesity, and locally available public transport tends to increase job opportunities and lead to fewer missed medical appointments. Education Research shows that those with higher levels of education tend to live longer and be healthier. In fact, one study, published in SERIEs, found that every additional year of school that an individual completes is associated with a 3.3% reduced risk of developing heart disease; 2.7% reduced risk of developing diabetes; 4.6% reduced risk of hypertension; and 7% reduced risk of developing arthritis. Overall, the study authors found that each additional year of accrued education led to a 6.85% reduction in the reporting of poor health. The reasons for this are myriad. Education improves individuals’ abilities to make more informed lifestyle choices, which can help them avoid unhealthy behaviors like smoking and binge-drinking. It also improves their likelihood of gaining financial security, which can lead to higher-quality housing, better nutrition, and easier access to healthcare. Access to healthcare According to the HHS, roughly 1 in 10 Americans don’t have health insurance. These individuals are less likely to have a primary care provider and may not be able to afford certain treatments or medications. As a result, conditions that are relatively simple to treat or manage may go unchecked and end up worsening over time. Likewise, these individuals may forego routine check-ups or screenings, which could improve early treatment and intervention. A lack of access to healthcare may be a result of lower-income, unstable or rural living location, or physical disabilities. Social and community context As it turns out, staying social as we age is huge when it comes to longevity. A person’s social network, and the interactions they have with friends, family, and members of their local community, can have a significant impact on health and well-being, according to HHS. Health-based interventions and social support from those who you see regularly can be critical to mitigating unhealthy behaviors and assisting in recovery from illness or chronic conditions. Research shows that living alone and having a small social network are risk factors for poor health in old age, particularly as aging decreases physical ability, and assistance can be vital for basic daily activities. Social support also boosts mental health. Socioeconomic status and race According to HHS, 1 in 10 Americans live in poverty, which decreases their access to nutritious food, healthcare, and safe housing. Research indicates that those with lower socioeconomic status tend to have worse health outcomes, and are also more likely to smoke, engage in less physical activity, and eat a less nutritious diet. Studies also show that lower socioeconomic status is associated with higher rates of disability, mortality, and illnesses like breast cancer. The CDC writes, “Across the country, racial and ethnic minority populations experience higher rates of poor health and disease in a range of health conditions, including diabetes, hypertension, obesity, asthma, and heart disease, when compared to their White counterparts. The life expectancy among Black/African Americans is four years lower than that of White Americans.” The COVID-19 pandemic disproportionately affected communities of color, another grim example of the ongoing health inequities in this country. “These health disparities underscore the urgent need to address systemic racism as a root cause of racial and ethnic health inequities and a core element of our public health efforts,” the agency wrote. Source
