Social Determinants of Health – Types, Significance, Inequality in the COVID-19 pandemic
The settings in which people are born, live, learn, work, play, and age are known as social determinants of health or SDOH. These non-medical elements influence a wide range of health, functional, and quality-of-life outcomes and hazards. SDOH includes socioeconomic position, education, neighborhood, physical environment, job, social support networks, and access to health care, among some important factors.
The global, national, and local distributions of money,
power, and resources affect these circumstances. According to the WHO, health
disparities — the unfair and avoidable differences in health status seen within
and between countries – are primarily caused by social determinants of health.
The public health community has been increasingly focused on
the socioeconomic determinants of health over the last two decades. However,
evidence has been collected that socioeconomic factors such as money, wealth,
and education are the root causes of various health consequences. People's
health, wellbeing, and quality of life are affected by SDOH.
Types of SDOH
According to CDC, the social determinants of health can be
broadly classified into five categories: healthcare access and equality,
education access and quality, social and community context, economic stability,
and neighborhood and built environment. The connection between people's access
to and comprehension of health services and their health is what healthcare
access and equality are all about. It comprises health coverage, access to
healthcare, provider availability, and quality of care.
The connection between education and health and wellbeing is
explored in Education Access and Quality. Years of study for the highest degree
can be used to determine educational level. It can be measured at three levels:
individual, home, and community. This includes literacy, language, early
childhood education, vocational training, and higher education.
The relationship between the qualities of the context in
which people live, learn, work, and play and their health and wellbeing is
known as social and community context. This involves community cohesion, civic
involvement, discrimination, employment conditions, and incarceration.
Economic stability involves the relationship between
financial resources like income, socioeconomic status, and cost of living to
the individual's health. Major factors included in this domain are poverty,
employment, food security, and housing stability. Neighborhood and built
environment involve association between an individual's place of living,
neighborhood, and environment to their health and wellbeing. Factors included
in this are quality of housing, access to transportation, air and water
quality, availability of quality food, along with neighborhood crime and
violence.
Significance of SDOH
According to research, SDOH can impact health more than
health treatment or lifestyle choices. Research implies that SDOH is responsible
for 30-55 percent of health outcomes. Furthermore, estimations reveal that
industries other than health contribute more to population health outcomes than
the health sector.
Improving health and eliminating health inequalities
requires addressing socioeconomic determinants of health. According to
research, various factors influence health outcomes, including underlying
genetics, health behaviors, social and environmental factors, and health
treatment. While there is no consensus in the research on the extent of these
elements' relative contributions to health, studies suggest that health
behaviors, including smoking, nutrition, and exercise, as well as social and
economic factors, are the key determinants of health outcomes.
For example, children born to parents who have not completed
high school are more likely to grow up in an unsafe environment, be exposed to
rubbish, and have bad housing. They also have less access to walkways, parks
and playgrounds, recreation facilities, and libraries. Furthermore, data
suggests that stress has a harmful impact on health across the lifetime and
that environmental factors may have multigenerational consequences. Addressing
social determinants of health is critical for improving overall health and
eliminating health inequities, which are frequently founded on social and
economic disadvantages.
SDOH and health disparities
The SDOH significantly impacts health disparities, which are
unjust and preventable differences in health status within and between
countries. Health and sickness follow a social gradient in countries of all
income levels. This implies that the lower the socioeconomic status, the poorer
the health is. According to WHO, people born in nations with high human development
(HD) have a 19-year advantage over those born in countries with low HD.
Subgroups with less education report 100 percent more "bad health"
than those with higher education.
The National Institutes on Minority Health and Health
Inequalities (NIMHD) launched a two-year science visioning process for health
disparities in 2015, hosting a series of workshops to propose prospective
research directions. Understanding why socially disadvantaged people have
disproportionately poor health outcomes has been a major focus of health
disparities research. The impact of social determinants of health on population
health and health disparities has been demonstrated by compelling scientific
data; nevertheless, the mechanisms and pathways involving social determinants
of health and how they contribute to health disparities are still unknown.
To combat health inequities, universal access to
high-quality care and an emphasis on equitable results are essential. It's also
important to address inequality in socioeconomic factors that lead to health
disparities.
SDOH and inequality in the COVID-19 pandemic
In racial/ethnic communities, there has been a rising focus on differences in COVID-19 incidence, prevalence, and death. The factors contributing to these differences could include social determinants of health and disease stigma. These populations are thought to be more sensitive to the virus due to social variables that underpin their health problems. Access to healthcare, economic insecurity, poor neighborhood and housing conditions, and resource availability are only a few determinants.
People's habits of social interaction, as well as their
sense of security and wellbeing, are influenced by where they live. Health
outcomes can also be influenced by the availability of services that improve
quality of life. According to WHO, COVID-19 incidence and fatality rates are
twice as high as in less deprived locations.
A growing number of programs to address social determinants
of health are emerging. Some of these programs aim to raise health-related
spending in non-health industries. In contrast, others aim to have the
healthcare system address larger social and environmental variables that
influence health.
References
Turner-Musa, J., Ajayi, O., & Kemp, L. (2020). Examining
Social Determinants of Health, Stigma, and COVID-19 Disparities. Healthcare
(Basel, Switzerland), 8(2), 168. https://doi.org/10.3390/healthcare8020168
Palmer, R. C., Ismond, D., Rodriquez, E. J., & Kaufman,
J. S. (2019). Social Determinants of Health: Future Directions for Health
Disparities Research. American journal of public health, 109(S1), S70–S71.
https://doi.org/10.2105/AJPH.2019.304964
Marmot, M., & Allen, J. J. (2014). Social determinants
of health equity. American journal of public health, 104 Suppl 4(Suppl 4),
S517–S519. https://doi.org/10.2105/AJPH.2014.302200
Braveman, P., Egerter, S., & Williams, D. R. (2011). The
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Beyond Health Care: The Role of Social Determinants in
Promoting Health and Health Equity. (2010). [Online] KFF. Available at:
https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity
Social Determinants of Health. [Online] Office of disease
prevention and health promotion. Available at:
https://health.gov/healthypeople/priority-areas/social-determinants-health
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https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
Social Determinants of Health: Know What Affects Health.
[Online] CDC. Available at: https://www.cdc.gov/socialdeterminants/index.htm
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