Renewing Our Focus on the Social Determinants of Health

This article by Equity Commons Co-Founder & Chief Equity Officer, Dr. Aubrey J. Grant, originally appeared in NJ Urban News

A person’s health is determined by far more than genetics and controllable behaviors. As a clinical cardiologist in Baltimore, I see firsthand the ways in which poverty, community violence, discrimination, and many other conditions undermine my patients’ health and longevity.

This complex web of interrelated factors is known collectively as the social determinants of health (SDOH), and many of these variables have an outsized negative impact on marginalized groups. 

On Tuesday, January 2nd, the Michigan Department of Health and Human Services took a meaningful step in honing focus on SDOH by recognizing January as the second annual Social Determinants of Health month (MDHHS Recognizes Social Determinants of Health Month in January, 2024). To that end, the department will mobilize resources throughout the month to build broader awareness and accelerate progress toward reducing health disparities driven by SDOH. 

The significance of SDOH cannot be overstated. These critical drivers of wellbeing include economic stability, education access, healthcare access, neighborhood and environment, and community context. Drilling down into even one of these five core pillars reveals their far-reaching influence – within the economic stability category, for example, we might consider income levels, housing status, job security, job opportunities, access to government aid, and more (Social Determinants of Health, n.d.). 

This new year, Michigan’s increasing focus on reducing inequities driven by SDOH should serve as a welcome nudge to improve our awareness of the ways SDOH impact the most vulnerable people in our communities. 

Unfortunately, many of these health influences are easy to overlook. Here are a few of the more insidious factors that you should understand as you learn more about SDOH. 

1. Access to nutritious, affordable food 

Experts agree that a nutritious, satiating diet plays a critical role in our health – particularly in the long term. Those with easy access to healthy food may take for granted that a nutritious diet is easy to sustain. 

Unfortunately, that is not always the case, especially for people living in food deserts. Food deserts, defined as low-income zones with low access to healthy foods (Morris et al., 2019), are alarmingly common in the United States – New Jersey alone has fifty such areas within its borders (NJEDA, 2023). 

Living in a food desert brings with it significant impediments to healthy eating. For one, healthy eating is more expensive in the United States; Cleveland Clinic notes that nearly half of Americans see a nutritious diet as being costly (Clinic, 2024). Additionally, food deserts lack geographical proximity to healthy food sources (Ney, 2022). 

As a result, it can be nearly impossible for people living in these areas to get the food they need to maintain their health – especially if they don’t have a car or are managing long work hours and family commitments. 

2. Neighborhood and community safety

Likewise, the safety levels of a neighborhood can drive its residents’ health in myriad ways. From a cardiovascular lens (my area of expertise), there is an expanding body of research that shows a positive association between rates of violent crime and cardiovascular mortality (Eberly et al., 2022). The relationship becomes obvious with the understanding that constantly fearing for one’s safety can, over time, induce a state of chronic stress that takes a heavy toll on the cardiovascular system. 

Zooming out, other avenues of influence from neighborhood safety to health outcomes become apparent. The deleterious effects of the immense stress that an unsafe neighborhood causes can manifest not only in biological processes but in coping and stress-reduction behaviors as well. Understandably, some of these behaviors can include the use of harmful substances which, when used chronically, negatively impact health (Amaro et al., 2021).  

3. Access to transportation

Access to transportation is another influence on health that car owners and those who live near reliable public transportation systems may take for granted. Transportation is, in effect, the conduit of access to the resources people need to live healthy lives. 

Take medical care as an example. Providers often do not live within walking distance of their patients, and without a reliable and affordable method of transportation, patients can face significant difficulty when trying to get the care they need. The Robert Wood Johnson Foundation notes that in 2022, 21% of adults without sufficient transportation access missed out on medical care they needed (Smith et al., 2023). 

Medical care is not the only health-influencing service rendered inaccessible for those without transportation options. Those living in food deserts on limited income and with low proximity to healthy food face further barriers to a nutritious diet when transportation challenges arise. Employment options also become limited if a longer commute is untenable. 

Looking Ahead

As Michigan improves its efforts to address SDOH-related disparities, the impetus on policymakers, clinicians, and our broader community across the United States to join the fight for equity in health grows stronger. 

We must continue to build collective awareness of the ways in which SDOH perpetuate inequity for marginalized groups. With a foundation of awareness and understanding, we can take meaningful action to drive sustained change in our communities. 

References

MDHHS recognizes Social Determinants of Health Month in January. (2024, January 2). https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2024/01/02/sdoh-month

Social Determinants of Health. (n.d.). https://health.gov/healthypeople/priority-areas/social-determinants-health

Morris, A. A., McAllister, P., Grant, A., Geng, S., Kelli, H. M., Kalogeropoulos, A., Quyyumi, A., & Butler, J. (2019). Relation of living in a “Food desert” to recurrent hospitalizations in patients with heart failure. The American Journal of Cardiology, 123(2), 291–296. https://doi.org/10.1016/j.amjcard.2018.10.004

NJEDA. (2023, July 31). Food Desert Relief Program. https://www.njeda.gov/food-desert-relief-program/

Clinic, C. (2024, April 30). Americans cite cost of heathy food as biggest barrier to a Heart-Healthy diet, according to Cleveland Clinic Survey. Cleveland Clinic. https://newsroom.clevelandclinic.org/2023/02/01/americans-cite-cost-of-heathy-food-as-biggest-barrier-to-a-heart-healthy-diet-according-to-cleveland-clinic-survey

Ney, J. (2022, January 25). Food deserts and inequality. DataVisualizationLab. https://www.socialpolicylab.org/post/grow-your-blog-community

Eberly, L. A., Julien, H., South, E. C., Venkataraman, A., Nathan, A. S., Anyawu, E. C., Dayoub, E., Groeneveld, P. W., & Khatana, S. a. M. (2022). Association between Community‐Level violent crime and cardiovascular mortality in Chicago: a longitudinal analysis. Journal of the American Heart Association, 11(14). https://doi.org/10.1161/jaha.122.025168

Amaro, H., Sanchez, M., Bautista, T., & Cox, R. (2021). Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism. Neuropharmacology, 188, 108518. https://doi.org/10.1016/j.neuropharm.2021.108518

Smith, L., Karpman, M., Gonzalez, D., & Morriss, S. (2023, April 26). More than One in Five Adults Forgo Healthcare Because of Transportation Barriers. RWJF. https://www.rwjf.org/en/insights/our-research/2023/04/more-than-one-in-five-adults-with-limited-public-transit-access-forgo-healthcare-because-of-transportation-barriers.html