Health is an elusive target that many of us invest a significant amount of time and money pursuing. Behaviors such as avoiding tobacco, eating a balanced diet, getting sufficient sleep, and engaging in stress management can help us make strides towards that goal.
But our ability to control our health is limited. And we rarely take sufficient time to assess the determining factors of our health that are beyond our control. In reality, while we can take charge of our health and engage in many health-promoting behaviors, our control over the entire concept of health is much smaller than we've been led to believe.
One of the most impactful determinants of health is established before we are born: our socioeconomic status. Our race, sex, food security, quality of education, social support, social norms, access to resources, and exposure to crime or violence all play a formative role in our ultimate health-related outcomes. And every one of these factors is beyond our control.
In the field of public health, these factors which determine health outcomes are called the Social Determinants of Health. As the name implies, these are social factors, rather than behaviors, which determine health status.
Five key areas of these determinants are: education, neighborhood or built environment, economic stability, social and community context, and health or healthcare. Within these classifications we find factors such as poverty, employment, high school graduation, literacy, incarceration, discrimination, access to healthcare, health literacy, risk of crime and violence, quality of housing, and much more.
Individuals who do not enjoy literacy or relative household safety are naturally going to be less likely to enjoy healthy outcomes. After all, we can tell a client or patient all day long that a balanced diet is optimal for health, but if they live in a food desert, we've done nothing but create stress rather than support. Similarly, if a client or patient needs to engage in more physical activity but cannot join a gym and does not live in a walkable neighborhood, their options are limited.
We now know that the impact of these social factors plays a substantial role in stress, adoption of healthy behaviors, and ultimately, nearly every adverse health outcome we target in public health.
The latest data on life expectancy in the United States reveal an average of 78.7 years overall, or specifically, 81.2 years for females and 76.2 years for males. Averages, however, don't tell the whole story. Life expectancy in the US varies dramatically by zip code, with wealthier, predominantly white neighborhoods enjoying a life expectancy up to 20 or even 30 years longer than neighboring zip codes with lower socioeconomic status (Murphy, 2018; Arias, 2018).
According to a 2019 Task Force on Maternal Mortality report, black women in New York City are approximately three times more likely to die during childbirth than white women. At least part of this disparity is attributed to the "impacts of individual and structural racism" on women of color.
Patients with higher levels of health literacy are more likely to utilize patient portals for information, data, and recommendations. This boost in health literacy boosts outcomes by empowering patients to better manage their conditions. But individuals with lower degrees of health literacy are less likely to use such technologies due to a distrust of the government, media, and technology. The social norm of skepticism ultimately produces poor health outcomes due to a reduction in health literacy (Mackert, 2016).
Many health professionals, particularly care providers, whether conventional physicians, health coaches, dietitians, or other areas of specialization, tend to assign their own cultural and social norms, resources, and habits to their patient or client. We assume the client has the same values, beliefs, knowledge, and tools we had prior to become a health professional, and we make recommendations based on our experiences and resources rather than the patient or client's.
This inhibits our ability to help the client achieve success. One of the first skills a health coach develops is the ability to assess a client's social determinants of health and work with them to identify goals and objectives which are attainable and specific to them. By identifying these determinants and working to overcome these barriers at every level of health, we produce far greater outcomes than is otherwise possible.
Mackert, M., Mabry-Flynn, A., Champlin, S., Donovan, E. E., & Pounders, K. (2016). Health literacy and health information technology adoption: the potential for a new digital divide. Journal of medical Internet research, 18(10), e264.