What are Social Determinants of Health?

Think health starts and stops at the doctor’s office?

Anyone who’s started a new diet or exercise regimen knows that’s not exactly how it works, but you might be surprised by factors that contribute to how healthy we are, such as the neighborhood we live in or the quality of education we received growing up.

Known as the social determinants of health, this broad concept is defined by the World Health Organization as the “conditions in the environments in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.”

At the most recent Health Forum of West Michigan, a panel of experts took up the issue.

“We know that social determinants of health are really changing the health care landscape,” said moderator Shannon Wilson, executive director, Grand Rapids African American Health Institute.

Susan Moran, senior deputy director, Population Health Administration at the Michigan Department of Health and Human Services, said social determinants of health are embedded in her agency’s mission. She said everyone deserves a chance at a healthy life regardless of socioeconomic factors, which account for 40 percent of how our health is determined. Thirty percent is determined by our health behaviors, 20 percent is clinical care and ten percent can be attributed to our physical environment.

Factors that affect health outcomes include poverty, early childhood development, education level, employment, food security, access to health care, housing stability, crime and violence, environmental conditions, language and literacy, and discrimination and social support.

In her work, Lauran Hardin contemplates the realities of social determinants of health daily. She’s the senior director of Cross Continuum Transformation at the National Center for Complex Health and Social Needs. In her previous work at Mercy Health Saint Mary’s, Hardin was tasked with figuring out who the hospital’s complicated, high utilizers of care were.

At first she hypothesized that they must be older with complex health stories. In reality, 70 percent were younger than 60 years old and they turned out to be vulnerable people dealing with mental illness, addiction, housing and transportation issues. Eventually Hardin led the charge to create a complex care center, which looked deeper into the root causes of why certain patients were using a disproportionate level of care and found that most had issues related to social determinants of health they were struggling with.

“It’s hard to care about disease management if you don’t have a safe place to live,” Hardin said.

Once patients received help through the complex care center, it led to reduced emergency room admissions and a reduction in outpatient visits. Hardin said there’s a movement to integrate addressing the social determinants of health in the health care system.

From a public health perspective, Moran said ignoring social determinants of health isn’t an option and cross-sector partnerships that address them will be critical in improving health for all.

Blue Cross Blue Shield of Michigan sponsors monthly Health Forum of West Michigan panel discussions. Register for the next event here.

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Photo credit: Victor Björkund

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