Social determinants of health – we hear about them all the time, but what are they really? Simply put, they are the things around us – beyond healthy habits – that determine our health outcomes. They are the conditions we are born into; where we work, live, and grow old, that influence our quality of life.1 For example, we know that smoking increases your likelihood for lung cancer, but did you know that things like where you live, the air you breathe, social support, and your education level can also impact your overall health?
Healthy People 2030 has identified five broad categories of social determinants of health – or SDoH – to “identify ways to create social and physical environments that promote good health for all.” These categories are 1) our neighborhoods and built environments, 2) health and health care, 3) social and community context, 4) education, and 5) economic stability.1 Each of these categories has a direct impact on our overall health.
Let’s use COVID-19 as an example. We know that minority communities have been hit hardest.2 And we also know that these communities are struggling to acquire vaccines.3,4,5 This is an example of how our built environment can impact our health outcomes. Many minority populations live in less affluent neighborhoods, are more likely have essential or “frontline” jobs, and have less access to resources and health care. These SDoH inequities have all contributed to the increased number of COVID-19 cases and deaths among minority groups in the United States.6
The water crisis in Flint, Michigan is another example of how SDoH play into our overall health outcomes. The World Health Organization argues that SDoH are shaped by the distribution of money, power, and resources, and the situation in Flint is a striking example. In 2014, Flint’s water source was switched from Lake Huron – controlled by the Detroit Water and Sewage Department – to Flint River.
The water in Flint River was corrosive, and no steps were taken to treat the water and to prevent lead and other harsh chemicals from leaking out of the pipes and into the drinking water. Lead is incredibly toxic, and once ingested, it is stored in our bones, our blood, and our tissues.7 There are no “safe” levels of lead exposure, and its damage to the human body is irreversible. In children, prolonged exposure causes delays in development, learning, and growth, and damages the brain and nervous system. In adults, it can lead to heart and kidney disease, high blood pressure, and reduced fertility.8
How did this happen? For starters, city officials needed a cheaper water source due to budget constraints. Flint is a poorer, predominantly Black city. Nearly 40% of its residents live in poverty.9 Because of conditions out of their control – primarily lack of city funds, and officials who chose a “wait-and-see approach10 instead of correcting the issue immediately – roughly 140,000 people unknowingly drank, bathed in, and cooked with lead-infused water for a year. A state of emergency was declared in 2016, but the residents of Flint will live with the effects of the lead poisoning for the rest of their lives. Perhaps most troubling is the fact that nearly 25% of Flint’s residents are children.
Flint’s water crisis is an extreme, but important example of how SDoH can impact individuals and communities. Often, the SDoH we encounter are less severe, and can be managed through education and advocacy. So, what can we as an organization do to manage SDoH impacting our members? State Medicaid agencies like Colorado Access can and are actively engaging in efforts to manage SDoH of members. Care managers play a critical role in educating members, identifying their needs, and providing resource referrals to alleviate barriers to care. Our health programming efforts and interventions also aim to mitigate barriers to care and improve health outcomes. And, the organization is in constant collaboration with community partners and state agencies to advocate for the needs of our members.
- COVID-19 Racial and Ethnic Disparities (cdc.gov)