At times, when we look at other people – whether we are a physician or not, we might make quick assessments about their health and choices. As human observers, we might wonder why some people seem to continue to make choices that are detrimental to their health – like smoking or eating unhealthy foods that contribute to weight gain.
The answers to these questions can sometimes go beyond willpower or genetic makeup. Factors that have to do with a person’s birth, upbringing and living conditions can greatly affect health outcomes. We refer to this as Social Determinants of Health, or SDoH.
Because SDoH are vast and varied, let’s focus on three major ones—income, education and cultural competence. Some other key SDoH include food security (defined as having reliable access to enough affordable, nutritious and culturally appropriate food), health literacy (the ability to obtain, read, understand, and use healthcare information to make good health decisions) and access to healthcare and social services.
Let’s start with income. The amount of money that a person earns directly affects several aspects of life. The neighborhood they live in, the sort of food that they can afford, and whether they can pay to see the doctor and purchase their medications are all determined by income.
If you see an overweight person for instance, they may have challenges exercising because they live in a low-income neighborhood where the crime rate is above the national average, making it unsafe to go for a morning jog or evening walk. This person may also live in a neighborhood that is in a “food desert,” where the closest grocery store offering affordable fresh fruits and vegetables is several miles away. Limited income may also impact the ability to own a car, and public transportation may be infrequent or unreliable.
The weight of poverty, the constant battle of not having enough, worrying about bills and making ends meet tend to keep people in a constant state of elevated stress. Stress has been proven to be linked to dozens of different health problems, including weight gain, high blood pressure, weakened immune system, aches, pains and mental illness. Sadly, maladaptive methods of dealing with stress can lead people to develop unhealthy coping habits such as smoking, illicit drug use, or excessive alcohol consumption.
Job prospects and earning potential often depend on education level – another major SDoH. There are multiple factors that determine the highest level of education that a person can achieve. Some people are born into families that do not value education and therefore do not impart its importance onto their children. Some families cannot afford to send their children to college, while others require their children to enter the workforce early to help support the family. Growing up in an unstable home that doesn’t provide the nurturing environment required for a child to thrive in school, contributes to school dropout rates. This in turn directly affects a child’s ability to develop a solid understanding of their own health, known as health literacy.
If you’ve never learned how to read food labels, how to prepare healthy meals, or been taught about the impact of eating too much sugar, fat and salt on the body, you are more likely to suffer from diabetes, heart disease and hypertension.
Let’s discuss cultural competence. Cultural competence is the ability to communicate and collaborate effectively with individuals from different cultures. It is a vital skill for physicians because it improves both healthcare experiences and patient outcomes.
As physicians, we really don’t know just by looking at our patients what they may have had to overcome to even make it to their appointment. For example, some might have had to arrange transportation, lean on social supports for babysitting help, or lost payment for time taken off from work. We owe it to our patients to be non-judgmental, respectful, and to listen to their concerns.
A culturally competent physician should be open and humble enough to learn about a patient’s background, their ideas about their health, and the barriers they face. Culturally competent care can involve offering interpretation services for patients with limited English proficiency, amongst other things. Everyone deserves a physician who will practice shared decision making and partner with them on their journey to optimal health and wellbeing.
There are several government and non-for-profit agencies that exist to help address the social determinants of health in the United States. For more information, you can visit the CDC website: Social Determinants of Health | CDC
The Hall County Health Department is another great resource, right here in Gainesville. Learn more and get involved: Hall County Health Department – District 2 Public Health (phdistrict2.org)