Social Determinants of Health (Exam Pt.2)

social determinants of health (SDOH)

conditions in which people are born, grow, live, work and age

• How a person’s context shapes their health and influence their health decisions

• Interactions with institutions, society

• What policies in place influence them?

• Ex: employment, income, housing, safety, language, education, hunger, community engagement, quality of care

SDOH Framework

Economic stability

Education

Social and community context

Health and healthcare

Neighborhood and built environment

How do SDOH influence health?

Differences in quality of care

Differences in access to health care

Differences in life opportunities, exposures, and stresses

what is the root cause of SDOH?

structural racism

examples of SDOH influence

1. Low income can lead to food insecurity, which impacts health

2. Lack of education limits job opportunities and income, which impacts health

3. Racism and other discrimination can lead to health inequities

Racism

structured system assigning value based on the social interpretation of how we view race

Leads to unfair disadvantages

Systematic

institutionalized racism

systematic distribution of resources, power, and opportunity in our society where groups are excluded/targeted based on race

• Initial historical insult, structural barriers, societal norms

interpersonal racism

prejudices leads to differential assumptions

Unintentional, acts of commission and omission, condoned by societal norms

internalized racism

acceptance by members of the stigmatized races of negative messages about their abilities and intrinsic worth

Reflects systems of privilege, societal values

racism influence on health

Institutional discrimination

Segregation creates pathogenic residential conditions

Internalized racism

Can create conditions that increase exposure to traditional stressors

interventions for racism

1. Policy reforms and anti-discrimination laws

   1. Strengthens civil rights protections

2. Health equity initiatives

   1. Expand medicaid and community health programs

3. Criminal justice reform

   1. Addressing sentencing disparities and policing biases

   2. Reducing mass incarceration through policy changes

4. Educational and economic investments

   1. Equitable funding for schools is marginalized communities

   2. Job training and economic development programs

5. Community-based approaches

   1. Advocacy and participatory policymaking

   2. Initiatives like Purposes Built Communities and Promise Neighborhoods

structural racism

system of interconnected institutions reinforcing racial discrimination in housing, education, employment, health care, and criminal justice

Intergenerational impact on wealth, education, healthcare access

Ex: first generation college students

Cultural and policy reinforcements of racial disparities

Ex: NIH funding forcing studies to remove words like “discrepancies”

historical context of structural racism

 institutionalized racism has shaped health outcomes from colonial times to present

structural vs. institutional racism

Structural racism is the interconnected systems that reinforce racial discrimination across society (housing, education, health, etc.), while institutional racism refers to discriminatory practices within specific organizations.

statistical disparities and scientific study findings among race

• Black Americans have higher infant mortality rates, lower life expectancy, and increased rates of chronic diseases

• Indigenous populations face elevated diabetes risk and heart disease

Scientific studies

• Research linking structural racism to stress biomarkers and adverse health outcomes

• Impact of discriminatory policies on health access and longevity

pathways of racism influencing health

1. Residential segregation

   1. Redlining and discrimination in housing

   2. Increased exposure to environmental hazards, poor living conditions, lack of access to quality health services

2. Economic inequities

   1. Disparities in income, employment, financial security

   2. Occupational segregation into lower-paying, high-risk jobs

3. Health care disparities

   1. Racial biases in medical treatment and diagnosis

   2. Limited access to health insurance preventive care

4. Criminal justice system

   1. Racial profiling, higher incarceration rates, legal penalties

   2. Long-term health impacts

5. Psychosocial stress and health outcomes

   1. Chronic stress from systemic discrimination leads to hypertension, mental health issues, increased mortality

key takeaways regarding racism

1. Racism and SES are not individual issues but deeply embedded in societal structures

2. Structural racism is a fundamental determinant of health disparities

3. Addressing systemic inequities requires policy changing

4. Sustained efforts to dismantle institutional discrimination and promote health equity for

why is work a key determinant of health?

Work influences health as it provides income, social connections, a sense of purpose, and access to health benefits. Employment conditions affect exposure to hazards, stress levels, and overall well-being.

what is the relationship between job status and chronic disease incidence?

inverse; better job status decreases likelihood of chronic disease incidence and vice versa

what type of research do we have on work and health?

understanding causal mechanisms linking work and health disparities

5 ways work influences health

1. income

2. working conditions

3. stress and mental health

4. work-life balance

5. occupational status

income influence on health

Employment provides income that determines access to healthcare, nutritious food, stable housing, and other social determinants of health. Jobs with health benefits improve access to medical care and preventive services.

working conditions influence on health

Workplace hazards such as exposure to chemicals, repetitive strain, noise, and physical dangers can lead to occupational illnesses and injuries. Psychosocial stressors like job insecurity or high-demand/low-control environments also impact mental and physical health.

work stress and mental health influence on health

Jobs with high stress, long hours, or lack of control can contribute to anxiety, depression, and burnout. Conversely, fulfilling and well-supported work environments can enhance mental well-being.

work-life balance influence on health

The ability to balance work with personal and family responsibilities affects overall health. Jobs with excessive hours or unpredictable schedules can disrupt sleep, increase stress, and limit time for exercise, social interaction, and healthcare visits.

occupational status influence on health

Employment shapes an individual’s social identity, sense of purpose, and social networks. Higher-status jobs are often associated with better health outcomes due to increased autonomy, financial stability, and access to resources.

link between work and health

1. Work organization

   1. Job stability, flexibility, and social capital affect long-term health

2. Precarious employment

   1. Contract, shift, and gig work increase stress, job insecurity, and health risks

3. Gender and occupational health

   1. Women in blue-collar jobs face unique risks

      1. Greater injury

      2. Job strain

challenges of assessing work and health

Difficulty in separating job-related stress from overall SES influences

Longitudinal studies needed to track cumulative psychosocial and physical risk factors

intervention strategies for work and health

1. Workplace policies

   1. Promote job security, fair wages, better conditions

2. Occupational health

   1. Regulations should address physical and psychosocial hazards

3. Future research

   1. Integrate social, economic, and biomedical factors to fully understand health disparities

key takeaways of work and health

1. Work is crucial in shaping health disparities across the social gradient

2. Interdisciplinary research

3. Addressing precarious employment and gender disparities

neighborhoods

geographic boundaries; in health, immediate residential communities

• Material and social characteristics related to health

• Defined by zip codes and census data

how does living in particular neighborhoods influence our health?

• Air we breathe, water we drink, food we eat

• Neighborhoods are marked by profound racial, ethnic, and socioeconomic differences

physical environment

built environment, land use, access to healthy food, pollution

social environment

social cohesion, safety, violence, collective efficacy

• Health behaviors (diet, physical activity) and stress pathways are key mediators

• Link between neighborhood SES to health outcomes

  • Associations between neighborhood deprivation and mortality, chronic disease, and mental health

    • Less consistent findings for self-related health, mortality, and chronic disease risk factors

challenges in studying neighborhood effects

1. Causal inference issues

   1. Selection bias

   2. Unmeasured confounding

2. Defining neighborhoods

   1. No standard geographic definition, varies by health outcome

3. measurement issues

   1. Reliance on self-reports induces bias

   2. Need for standardized assessment tools

future directions for neighborhoods on health

1. Longitudinal and life course studies

2. Intervention research

3. Natural experiments

4. Systems thinking and simulation models

5. Gene-environment interaction

food deserts

• 23.5 million people live in food deserts

  • Due to:

    • Large-chain supermarkets

    • Closure of smaller grocery stores

    • Access to healthy foods is challenging

  • Minorities more likely to live in food desert

    • Higher risk of noncommunicable diseases

    • Leads to poor diet, obesity, heart disease

Examples:

1. Los Angeles, CA

   1. Low poverty

   2. Predominantly white have 3.2x as many supermarkets as predominantly white neighborhood

2008 farm bill

farmers were given financial assistance due to excess crop supply, creating low prices and controlling and ensuring an adequate food supply

healthy food financing initatives

launched by Obama administration, equips grocery stores and farmers market to sell healthy food in underserved areas

Key takeaways of neighborhoods influence on health

1. Neighborhoods are key determinants of health 

2. Policies shaping neighborhoods should be leveraged for health improvements

3. Interdisciplinary research and interventions are needed to address structural determinants of health inequities

socioeconomic status

 individuals position within a hierarchical social structure in relation to others 

• Typically based on income, education, occupation

• Reveals differences in access to resources, exposure to toxic substances and hazards

Material resources: access to nutritious food, safe housing, health care services

Psychosocial factors: stress levels, social support, sense of control

Health behaviors: variations in smoking, exercise, dietary habits

SES stress exposure

higher chronic stress in lower socio-economic groups, leading to adverse health effects

SES control and autonomy

lower socio-economic individuals experience less control over life circumstances, impacting health

SES access to information

lower socio-economic status may limit access to health-related information and resources

how do we measure SES?

1. education

2. total income

3. occupation

why do we measure SES?

• There is an evident socioeconomic gradient in health

• The lower an individuals SES, the worse their health

gender-health paradox

females have higher life expectancy, however, they suffer from more chronic and non-life threatening illnesses; males have higher mortality due to life-threatening conditions; females experience more depression/anxiety while males have higher substance abuse and antisocial behaviors

cardiovascular disease and gender

Males have early onset at earlier age

Females have increase risk postmenopausal

Historical research bias toward men has delayed understanding of females

immune disease and gender

Females have stronger immune response but higher risk

Hormonal differences contributed to immune function variations

mental health and gender

females have higher rates of depression; men have more externalized disorders (aggression)

Gendered coping mechanisms influence mental health disparities

medical exploitation of enslaved black women

• 1808; ban on slaves, owners encouraged to focus on reproductive of slaves

• Dr. Sims is praised as father of OB/GYN; committed heinous crimes against women in Alabama (Anarcha, Lucy, Betsey)

• 1830s, Dr. Prevost practiced C-section on enslaved women without anesthesia

  • Believed Black people experienced less pain than White’s

• Racial bias in pain persists today

• Black and American Indian women have higher pregnancy-related death compared to White women

forced sterilization of black women

• Sterilized them to lower population rates

• Didn’t have to deal with the mental illnesses that people of color had (illness was that they wanted civil rights)

• 1927 US Supreme Court affirmed the Sterilization Act of 1924

gender bias

prejudice that favors one gender over the other

sex

biological characteristics determining one’s sexuality

gender

based on how someone identifies

• almost everyone has a gender bias

  • masculine vs feminine

explicit bias

person is aware

implicit bias

person is unaware

examples of gender bias

1. 2018 study revealed doctors view men with chronic pain as brave, but view women as emotional

   1. Doctors were more likely to treat women’s pain as a product of mental health condition rather than a physical ailment

2. Gender bias can lead to discrimination against health workers

   1. 2020 study revealed older women doctors found age and gender based harrassment, discrimination, and salary inequity persisted throughout their careers

3. Lack of inclusivity in studies, leaves doctors with a limited understanding of female and intersex health

• Healthcare stigma against transgender individuals and persons of color

consequences of gender bias

1. Knowledge gap

   1. Lack of inclusivity

2. Lack of women in leadership

3. Delayed diagnoses

4. Inadequate symptom management

5. Avoidance of medical care

6. Abuse, neglect, and death

affordable care act

health insurance reform law that was signed into law in 2010

abortion ban

14 states enforcing total bans; 2022, US Supreme Court overturned abortion rights

• 43 states prohibit some abortions after a certain point in pregnancy

• Impacts services available, where physicians will want to practice

• Proactive policies