The Social Determinants of Health
Lara’s health tells the story of her life. It tells of her genetics and her dietary and activity choices. But more than that, Lara’s health tells the story of the community where she lives, learns, works and plays. Her health is a narrative of her access to healthy foods to nourish her body and affordable health care. It chronicles the reliability of public transportation, the quality of schools, and the availability of well-paying jobs and supportive childcare. It reflects the level of support that community members provide to each other and the power that Lara and her neighbors hold and use to speak out for change. It also tells of the bias and systemic oppression Lara faces because of her ethnicity, gender, and class. Lara’s health is the story of the social determinants that surround her and how they impact her ability to live a long, healthy life.
Like Lara, every person’s life is impacted both positively and negatively by the social determinants of health in their community. Supportive social environments can allow residents to help each other, while residents who are discriminated against may be cut off from resources or assistance. A well designed built environment allows for walkable access to stores, playgrounds and schools, while a crumbling infrastructure may leave children stranded inside, unable to run and play, or subject to the dangers of traffic when venturing outside. High quality educational systems empower children to succeed in life and to contribute to their community and families, while failing schools limit prospects for future achievement. Efficient transportation systems allow people to move easily between jobs, shops, school, their doctor’s office and home, while poorly designed ones can leave people without an easy way to get to work each day. Limited access to high-quality, affordable health care and foods can undermine health and make it difficult for children and adults to thrive. Punitive criminal justice systems can remove potential role models and income providers from families while subjecting families to a cycle of fines and fees that strip them of precious wealth. Unaffordable or unsafe housing and income insecurity can leave families without the security needed to be safe and thrive. Poor environmental quality might mean residents are unfairly exposed to unclean air and water that increases their chances of experiencing disease and early death.
All too often, systemic oppression lays at the root of health inequities and how people and communities experience the social determinants of health. Racism, sexism, classism, heterosexim, ableism, and xenophobia tangibly affect the health and quality of life of individuals. Low-income children of color, for example, too often live in segregated neighborhoods with poor quality schools, housing, and services and limited employment prospects. These neighborhoods may experience safety hazards, limited role models, and other challenges that can kill hope and limit optimal health.
One key solution to addressing health inequities comes from an important social determinant of health: community power. Residents with the strength, courage, and ability to speak up and demand changes in their circumstances can transform the health of their communities. At the same time, community leaders and residents who embrace the values of fairness and inclusion can use an equity framework to advance opportunities for their neighbors living in marginalized communities to lead healthy and long lives.