As a country, we spend nearly 20% of our gross domestic product, or more than $4 trillion annually, on health care. Nevertheless, we continue to lag many other countries in health-related outcomes, such as life expectancy. During the COVID-19 pandemic, for a variety of direct and indirect reasons, preliminary evidence suggests that life expectancy actually dropped – particularly so among racial and ethnic minorities.
Having spent a professional career in primary care medicine and public health, it is sometimes frustrating to admit the limited impact of my interventions as a physician on the health in a community. Certainly, it is true that medical management of chronic conditions like diabetes or heart disease is critical to an individual patient’s well-being. It is similarly true that preventive health care services ranging from prenatal care to immunizations and blood pressure screening improves the health of groups of people.
Yet, there are other factors outside the direct influence of the health care team that play an outsized role in the health of communities. These so-called social determinants of health, also known as social drivers of health, have a major impact on people’s health, well-being and quality of life and may account for 70% to 80% of population health outcomes. They are also responsible for most of the health disparities and inequities affecting minority groups.
According to the U.S. Office of the Assistant Secretary for Health, social determinants of health include safe housing and neighborhoods, safe and reliable transportation, education, job opportunities, and income, access to nutritious food, and opportunities for physical activity, and both language and literacy skills. Social drivers of health also include racism, discrimination and violence and the impacts of polluted air and water.
One of the main goals of Healthy People 2030 is to “create social, physical and economic environments that promote attaining the full potential for health and well-being for all.” This includes public health engagement and partnership with sectors like education, transportation, and housing to address the “upstream” factors (unrelated to health care delivery) in community environments that impact health.
The social determinants of health are grouped into five domains that include economic stability, education access and quality, health care access and quality, neighborhood and built environment, as well as social and community context.
Like my colleagues in health care, I have become increasingly aware of the complex environmental variables that affect the health-related outcomes of my patients. Bringing clean running water to a community that lacks it, promoting access to high quality education and health literacy, removing racial barriers that block occupational opportunities, ensuring safe housing and neighborhoods, and working to protect air quality are just as important, if not more important, than the treatments offered within the four walls of a health care facility.
Now that’s a prescription for a healthy community.
Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.