Social determinants of health are the environmental conditions people are born, worship, learn, live, work, play, and age that affect a wide range of quality-of-life, health, functioning, and risks. Conditions (e. g. , social, economic, and physical) in these various environments and settings (e. g. , school, church, workplace, and neighborhood) have been referred to as “place. ” In addition to the more material attributes of “place,” the patterns of social arrangement and sense of security and wellbeing are also affected by where people live.
Resources that improve quality of life can have a major impact on population health outcomes. Some examples include safe and affordable housing, quality education, public safety, healthy foods availability, local emergency/health services, and environments free of life-threatening toxins. Education, social and community context, the living environment, Economic stability, health and health care, all are factors in social determinants of health.
Interventions aimed at reducing health inequalities have been evaluated, and developed, but tend to focus on changing lifestyle choices like smoking. This may reflect the fact that lifestyle issues are often easier to identify and treat, or it may point to differences in the respective evidence bases; with evidence on managing major social issues being less apparent and less accessible to lawmakers and clinicians. Evidence about what can actually be done to manage the social determinants of health is required, specifically which interventions are most appropriate and for whom.
Good health follows a social gradient and typically flows in the positive direction with increasing socioeconomic status; The importance of the social (as opposed to biological or genetic) causes of this increase for example, housing quality, access to healthcare or quality of work, has also been established. This has led to increasing pressure in research, practice and policy-making environments to investigate these wider social determinants of health, through the implementation of appropriate interventions, and thereby reducing the gradient and health inequalities.
The CDC Health Disparities and Inequalities Report – United States which was issued in 2013 reported on some of the key factors that affect health and lead to health disparities in the United States (CDC, 2013). Four findings bring home the enormous personal tragedy of health disparities: Cardiovascular disease is the leading cause of death in the United States. African American adults are twice as likely to die of stroke or heart disease (prematurely) than non-Hispanic whites.
Adult diabetes rates are higher among Hispanics, non-Hispanic blacks, and those of other or mixed races than among Asians and nonHispanic whites. Prevalence is also higher among adults without college degrees and those with lower household incomes. African Americans have almost double the infant mortality rate for non-Hispanic whites. Geographically, rates are higher in the South and Midwest than in other parts of the country.
The term disparities is used when describing racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. health disparity as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.
Health disparities adversely affect people or groups of people who have experienced greater challenges to health based on their racial or ethnic group; religion; socioeconomic status, gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.
Efforts to reduce disparities and achieve health equity have primarily been focused on diseases or illnesses and on clinical services. Good health is not always indicate the absence of disease. Undiagnosed or unrecognized diseases may impact quality of life in the elderly years. Complexed, powerful relationships exist between health and biology, genetics, and individual behavior, and between health and health services, socioeconomic status, the physical environment, discrimination, racism, literacy levels, and legislative policies.
These factors, which influence an individual’s or population’s health, are known as determinants of health. Recognizing the continuing problem of disparities, the Department of Health and Human Services (HHS) developed an action plan for reducing racial and ethnic health disparities. The HHS Disparities Action Plan establishes a vision of, “a nation free of disparities in health and health care,” and sets out a series of priorities, strategies, actions, and goals to achieve this vision.
The action plan builds on existing HHS initiatives, such as the Healthy People initiative. States, local communities, private organizations, and providers also are engaged in efforts to reduce health disparities. The Affordable Care Act (ACA) advances efforts to reduce disparities and to improve health and health care for vulnerable populations. The ACA health coverage expansions will significantly increase coverage options for low- and moderateincome populations and particularly benefit vulnerable populations.
The ACA also includes provisions to strengthen the safety-net delivery system, improve access to providers, promote greater workforce diversity and increase cultural competence, strengthen data collection and research efforts, and implement an array of prevention and public health initiatives. health and health care disparities remain a persistent problem in the United States, leading to certain groups being at higher risk of being uninsured, having more limited access to care, experiencing poorer quality of care, and ultimately xperiencing worse health outcomes. While health and health care disparities are commonly viewed through the lens of race and ethnicity, they occur across a broad range of dimensions and reflect a complex set of individual, social, and environmental factors.
Disparities limit continued improvement in overall quality of care and population health and result in unnecessary costs and are increasingly important to address as the population becomes more diverse. For the past decade, eased focus on reducing disparities and a growing set of initiatives to address disparities at the federal, state, community, and provider level. The ACA includes provisions that advance efforts to eliminate disparities. As the population becomes increasingly diverse, it will be important to increase focus on and recognition of disparities and for there to be broad and integrated efforts to address the wide range of factors that contribute to disparities, including social and environmental factors that extend beyond the health care system.
