Week-3 Social Determinants of Health & Health Disparity

Where does health come from?

Clinical care accounts 10-20% of what determines health outcomes at the

population level.

Health behaviors, social and economic factors, and physical environment account for the rest.

Behaviors themselves are shaped by the conditions around them.

"Choice" is constrained by what is available, affordable, and safe

Social Determinants of Health

SDOH: the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with

illness.

• These circumstances are in turn shaped by structural

determinants

• Broader systemic factors that influence social determinants and

create conditions in which people live.

Education Access and Quality

Early childhood education improves cognitive development and long-

term health.

• Education levels correlate with income, job security, and behavioral

outcomes.

• Adults with lower educational attainment have higher rates of major

circulatory diseases; diabetes; liver disease

• Education as a pathway to health

• More education means access to better economic resources (jobs

with health benefits and fewer risks)

• Opportunity to live in healthier neighborhoods (less pollution)

• Proper management of conditions such as ADHD or asthma can

improve a child's academic success.

Healthcare Access and Quality

Access to health care

2. Access to primary care

3. Health insurance coverage

4. Health literacy

Lack of access to healthcare can lead to delayed diagnoses, inadequate

treatment, and preventable diseases

• Tertiary care/ downstream approach

• Uninsured individuals are less likely to receive timely and necessary

care.

Neighborhood and Built Environment

Poor-quality housing can lead to respiratory issues, injuries, and mental health

problems.

Living in areas with high pollution or limited green spaces can contribute to respiratory

diseases and obesity.

Access to affordable transportation is essential for healthcare appointments,

employment, and education

Social and Community Context

1) Social connection improves mental health and reduces risk for

chronic stress.

2)Experiences of racial, gender, and social discrimination can lead to

chronic stress.

3) Involvement in community activities promotes a sense of belonging and encourages healthier behaviors.

Social Connection and Health Outcomes

COHORT STUDY (N=1363) STUDY

FOUND AN OVERALL 27%

INCREASED RISK OF DYING FOR

INDIVIDUALS FEELING LONELY

COMPARED WITH NON-LONELY

INDIVIDUALS

Economic Stability

Employment influences physical and mental well-being.

Lower income limits access to services, food security, education, safe

housing, community spaces for physical activity, and healthcare.

Individuals who live in poverty are more likely to experience higher rates

of diabetes and hypertension.

Poverty and Health

•Poverty is both a cause and a consequence of poor health.

• Marginalized groups and vulnerable individuals are often worst affected, deprived of the information, money, or access to health services

that would help them prevent and treat disease.

• The cultural and social barriers can mean these groups use health services less, with serious consequences for their health.

SDOH and Poverty

U.S POVERTY RATE 11.1% IN 2023= 36.8 MILLION

PEOPLE

• Poverty often occurs in concentrated areas and endures for long

periods of time.

• Some communities, such as certain racial and ethnic groups,

people living in rural areas, and people with disabilities, have a

higher risk of poverty for a myriad of factors that extend beyond

individual control.

SDOH vs. Social Needs

SDOH: population‑level conditions that shape health

risks and resources.

Social needs: person‑level acute resource needs (e.g., housing, transportation, food) that must be met to achieve good outcomes.

Social Determinants, Social Needs, and Social Risk

Social risk factors: specific adverse conditions associated with poor health, such as food insecurity or housing instability. Measured at the individual level.

• Social needs: what the individual person identifies as a priority for themselves.

Requires asking them

• An individual can have a social risk factor and not name it as a need, and vice versa.

• Screening for needs in a clinic is not the same as changing determinants in a community.

The Effects of Different Zip Codes, Unequal Burden

of Disease

POC, low‑income, and rural residents experience higher disease burden and shorter life expectancy.

These gaps have widened over time.

The roots are structural and complex.

Important to understand how and why SDOH play a role.

Fundamental Cause Theory

Link and Phelan (1995): socioeconomic status is a fundamental cause of disease, not simply a correlation.

Evidence: the association between SES and mortality persists across centuries even as the specific diseases change completely.

Why? Higher-SES people command flexible resources: money, knowledge, power, prestige, and beneficial social connections.

Those resources can be adjusted to current health threats.

Key Terms Review

• Health difference: any variation between groups, including harmless ones

• Health disparity: a difference that is closely linked with social, economic, or environmental disadvantage, adversely affecting groups that have

faced systematic obstacles

• Health inequity: a disparity that is unnecessary, avoidable, unfair, and unjust. This word contains a moral claim

• Health equity: everyone has a fair and just opportunity to attain their highest level of health. It is the goal, not a measurement

• Equality is the same input for everyone. Equity is the input each group needs to reach the same outcome

Social Justice

A disparity becomes an injustice when three conditions hold: it

is systematic, it is socially produced, and it is avoidable

• Social justice claim: an assertion for the fair and equitable

division of resources, opportunities, and privileges within a

society, particularly for marginalized or oppressed groups.

• The contrasting position holds that health is primarily an

individual responsibility and its distribution reflects individual

choices.

• Most real policy debates in public health are arguments between

these two frames (even if terms not used)

• Public health as a field has taken a position- social justice is

written into its professional codes and its accreditation

standards

In-Class Assignment- Background Information

Cervical Cancer is caused by certain types of human papillomavirus (HPV). It was the leading cause of death in

young women the early 20th century (1900-1930s). Death rates were roughly similar across income groups and

race/ethnicity groups.

• Pap smear was introduced in the 1940’s. Test is quick, cost-efficient.

• Widespread screening programs began in the 1950s and 1960s. Cervical cancer mortality in the United

States fell by 70% over the following decades

• HPV vaccine was introduced in 2006

• Overall mortality fell, the gap in cervical cancer death rates between higher-income and lower-income women

grew wider than it had been before the test existed.

• Present day - cervical cancer mortality in the United States is concentrated among low-income women,

uninsured women, rural women, and immigrant women