What are the Social Determinants of Health?
The social determinants of health are non-medical factors that influence health outcomes. These factors vary greatly from individual to individual, and can impact on a person’s overall health and life expectancy.
Multiple factors are considered to be social determinants of health, and these include:
- Income and job security
- Neighborhood and physical environment
- Food security
- Community and social support networks
- Access to healthcare
How Important are Social Determinants of Health?
Addressing social determinants of health is crucial to improve health and reduce longstanding disparities in healthcare. It seems logical to view the healthcare system as a key driver of health outcomes and although healthcare is essential to good health, it is a relatively weak health determinant. More research is needed to determine the relative impact each factor contributes to health, but studies show that socioeconomic factors can shape individuals’ health and lifestyle behaviors – and we know behavior is key in addressing chronic disease in particular.
The USA spent $4.3 trillion on healthcare in 2021, and by 2030 the health spending share of GDP is projected to reach 19.6%, higher than in any other country at $6.8 trillion. However, the vast proportion of spending on healthcare is not matched by corresponding positive health outcomes. The USA spends more on healthcare than any other high-income country, but has the least to show for it, in terms of population health. Over 60% of Americans have a chronic disease, the current leading cause of death in the USA.
Put into context, this is not altogether surprising. The actual make-up of good health, namely healthy behaviors, genetics, environmental factors and access to healthcare, are not given proportionate investment in the US healthcare system, with an overwhelming majority of 88% of spending being plunged directly into medical services (Fig. 1).
The Covid-19 pandemic has served to only widen the socioeconomic and racial disparities in healthcare access, highlighting the urgent need to look beyond healthcare systems to reduce the inequity in health outcomes in the USA and across the world.
Achieving Health Equity
Empirical data from the Organization for Economic Cooperation and Development (OECD) between 1995-2015 showed that adults with lower educational attainment had worse health and reduced lifespans compared to their more well-educated peers.
The provision of early childhood education programs in the USA to children in low-income families and communities of color has been shown to help to reduce achievement gaps, improve the health of low-income students, and promote health equity.
Non-wealthy Americans have suffered from lack of healthcare cost coverage and even those who are privately insured have had their wage gains undermined by rising premiums. This higher risk of poor health in those who are financially disadvantaged is clearly seen in the 2011 National Health Interview Survey, where the highest proportion of adults in the USA with self-reported poor health were found to be earning low incomes, below $35,000/year.
The Medicare and Medicare plans offer some support for healthcare to those on lower incomes, but they do not capture the whole socioeconomically disadvantaged population. Some Americans may have insurance provided by their employer, but equally, job insecurity is felt more keenly by those earning on the lower end of the spectrum, leading to a potential negative feedback loop of poverty.
The Earned Income Tax Credit (EITC) provides financial assistance for low-income workers and has demonstrated an association with decreased low-birthweight infants and infant mortality. This is a stop-gap initiative, however, and policy change is required to ensure more permanent downstream effects on income and health.