Social determinants of health

It may be intuitive to those who are public health-minded, but one's environment influences one's health. Social determinants of health has a large body of literature, and this post will attempt to summarize it.

According to the WHO, the social determinants of health are "the conditions in which people are born, grow, live, work and age, including the health system." A person's circumstances heavily influences his or her health status as well as overall health inequities.

Recently, the NYTimes and the Robert Wood Johnson Foundation reported that "research suggests social circles influence public health behaviors." For example, one study cited in the article found that a person's risk of obesity increased by 10% when a friend gained weight. According to this pie chart, lifestyle can determine up to 51% of one's health. If that lifestyle is centered around unhealthy environments and behaviors, influenced by one's surroundings, we can improve health drastically by changing one's surroundings.

This image, from the Commission on Social Determinants of Health's final report, illustrates the relationship between determinants of health and health inequities. The report says, "the structural determinants and conditions of daily life constitute the social determinants of health and are responsible for a major part of health inequities between and within countries." This Commission called for three areas of action: to tackle the daily living conditions in which people are born, grow, live, work and age; to tackle the structural drivers of those conditions at global, national and local levels; and to carry out more research to measure the problem, evaluate action and increase awareness.


There are several reasons and theories of why socioeconomic status (SES) influences health so heavily. I won't detail them in this posting as there are many articles that do so quite well (try here and here). Included in the theories are reasons of income disparities, social capital, racial discrimination, access to medical care, social support, and more. Lifestyle and physical environment causes may explain many of these issues; these two factors point to broader cultural and social trends that construct a framework in which health may be 'doomed' to be poor.

There are numerous articles citing the lack of healthy eating options, sidewalks, and safe neighborhoods for poor communities. Driving in Atlanta, this situation is abuabundantly clear. The nice neighborhoods have great grocery stores, walkable sidewalks, and overall lovely atmospheres; in contrast, the poorer neighborhoods have small and dingy grocery stores, unwalkable streets, and rundown atmospheres. These poor environments are not conducive to healthy eating or physical activity, but perhaps more importantly they may make it difficult to have a happy and meaning life with high social capital and support, crucial to overall well-being.

In sum, there are a number of factors beyond genetic makeup and personal behaviors that determine health status. These factors are crucial for public health to address in order to improve the population's health.

Sculptures

"Sculptures" is probably the last thing you thought you'd see as a blog post title here. Luke Jerram has produced these beautiful sculptures - of diseases... specifically, E. coli, HIV, and H1N1 influenza. Aren't they cool?

E. coli

HIV

H1N1

Sesame Street encourages you to be healthy!

Even Sesame Street is urging you to be healthy! This is a cute little video featuring Elmo.

Competing priorities

Public health has always faced the challenge of competing priorities. Is a vaccination campaign more important than a healthy lifestyle campaign? Should the focus be reducing cancer rates or improving infant mortality? There are thousands of possibilities.

This year, the obvious challenge is that H1N1 is taking over the world. According to some estimates, 90,000 may die of H1N1 this season. While CDC doesn't like that estimate, the media has caught hold of it and hyped it up. Another estimate says that 12-24% of the population could get H1N1, up from 6-8% this spring. Whatever the situation ends up being, it's definitely getting people's attention.

This perhaps over-hyped attention is taking the focus away from just about every other public health issue going on right now. For example, CDC just announced that life expectancy hit an all-time high of 77.9 in 2007. $26 million will be spent on opening new health centers across the country. And sales of tobacco to underage youth fell to a new low. This article discusses how preparations for influenza have delayed an obesity initiative at a Boston area school.

While H1N1 may indeed turn out to be quite dangerous, and we need to adequately prepare for the next wave of the pandemic, we also need to keep in mind other public health issues affecting people every day. Obesity initiatives, safety measures, food safety, and other issues need to be at the front of our minds too. Because after the H1N1 scare dies down, our children will still be overweight, our environments not safe enough, and our food not secure.