Tuesday, 20th August, 2024
Authors: Vinh Pham
Country: United States
Source: Seraine Page
SUMMARY
The health of Americans isn't just about doctors and medicines. It's also about where people live, how much money they make, and their education. These things are called Social Determinants of Health (SDOH). They have a big impact on how healthy people are. In the US, these factors often lead to some groups being healthier than others.
BACKGROUND
There are five main areas of SDOH: Money and jobs, Education, Healthcare, Neighborhoods, and Social connections. These things all work together to affect health. For example, people with more education often have better jobs, which means more money and better housing. All of this leads to better health. Someone with a good education might get a job with health insurance, be able to afford healthy food, and live in a safe neighborhood with parks for exercise. All of these things help them stay healthier.
In the US, these factors create big health differences. In some cities, people in one neighborhood might live 20 years longer than people just a few miles away. This isn't fair, and it's not just about personal choices. For instance, in Washington D.C., people in the wealthy neighborhood of Chevy Chase live on average 16 years longer than those in the poorer area of Anacostia. This huge difference is mostly because of things like better access to healthy food, safer places to exercise, less stress, and better healthcare in the wealthier area.
Race plays a big role too. Black Americans often have more health problems than White Americans. This isn't because of genes - it's because of long-standing unfairness in things like education, jobs, and housing. For example, Black Americans are about 60% more likely to have diabetes than White Americans. This isn't because of biology, but because of things like less access to healthy food in many Black neighborhoods, higher stress from discrimination, and often less access to good healthcare.
COVID-19 really showed how these factors affect health. People in crowded housing or who couldn't work from home got sick more often. Essential workers, who are often from minority groups and lower-income backgrounds, were more exposed to the virus. They often couldn't afford to take time off work, even when sick. This led to higher rates of COVID-19 in these communities.
Fixing these problems isn't easy. It needs changes in many areas, not just healthcare. Some ideas being tried are: new laws to make things fairer, like increasing the minimum wage or improving housing standards; community programs to help people, such as food banks or job training programs; and doctors addressing social needs, not just medical ones. Some clinics now have social workers to help patients with things like housing or food insecurity. There's also a push for teaching people about how these factors affect health, both in schools and in the community. Another important strategy is getting different groups to work together, like having schools, hospitals, and community organizations collaborate on health initiatives.
Recent policy changes have also started to address SDOH more directly. For example, the expansion of Medicaid in many states has improved healthcare access for low-income individuals. Some cities have implemented rent control measures to address housing affordability. Additionally, there's been a growing focus on incorporating SDOH into healthcare payment models, encouraging providers to address social needs alongside medical ones.
Technology is playing an increasingly important role in addressing SDOH. Telemedicine has improved access to healthcare for people in rural areas or those with transportation barriers. Some health systems are using artificial intelligence to identify patients at high risk due to social factors. There are also mobile apps that help people find local resources like food banks or affordable housing. These digital tools are making it easier to connect people with the services they need to stay healthy.
But there are challenges. These issues are deeply rooted in society and can be politically sensitive. Some people think individuals should be responsible for their own health, without considering how much these social factors influence personal choices. As we learn more about SDOH, it's clear that making everyone healthier means looking beyond just medical care. It requires addressing unfairness in society as a whole. This is a big job, but it's crucial for creating a healthier, fairer society.
REFERENCES
Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl 2), 19-31.
Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., ... & Cutler, D. (2016). The association between income and life expectancy in the United States, 2001-2014. JAMA, 315(16), 1750-1766.
Williams, D. R., & Mohammed, S. A. (2013). Racism and health I: Pathways and scientific evidence. American Behavioral Scientist, 57(8), 1152-1173.
Bambra, C., Riordan, R., Ford, J., & Matthews, F. (2020). The COVID-19 pandemic and health inequalities. Journal of Epidemiology and Community Health, 74(11), 964-968.
Marmot, M., & Allen, J. J. (2014). Social determinants of health equity. American Journal of Public Health, 104(S4), S517-S519.
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