In November 2023, the Biden White House released the 53-page U.S. Playbook to Address Social Determinants of Health and declared: “Improving health and well-being across America requires addressing the social circumstances and related environmental hazards and exposures that improve health outcomes.” It accepted the Department of Health and Human Services’ definition of SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”[1]
These claims are based on some stark facts. Low-income Americans have higher rates of disability, anxiety, heart disease, stroke, diabetes, and other chronic conditions, and they are more subject to obesity, substance abuse, physical strain, and environmental pollutants.[4] From 2001 to 2014, the life expectancy of the richest 1% of Americans averaged 15 years longer than that of the poorest 1%.[5] Furthermore, poorer social classes have worse health outcomes even when they receive the same access to medical care.
Possible sources of SDOH influence
Neighborhoods
Air and water quality
Hazards (lead paint, vermin, mold, dust, infectious disease)
Service availability (schools, transportation, medical care, employment)
Education
Knowledge of healthy behaviors
Employment opportunities (conditions, compensation)
Economic
Personal income and wealth
Workplace safety (injuries, chemical exposure, repetitive strain)
Work pressures (stress, sleep, social support, financial anxiety)
Social relations
Social harmony (crime, violence, anxiety, social trust)
Racial disadvantages (discrimination, prejudice, animosities)
Community ties (social status, social networks)
Cultural pressures (substance use, illegal activity, diet, exercise)
Feedback cycle between ill-health and poverty
In addition, low-income areas are often healthcare deserts, where there are no providers, or pharmacies, and poor transportation.
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