Social Determinants of Health Inequity

A variety of different factors go into determining the health of a community. There is no shortage of health data with numbers for how many hospital beds and how many chases of bronchitis there are each year, but social indicators also paint a picture of health for your community.

Beyond traditional reports on physical and mental well-being, the health of a community can be further understood using social and economic data. In order to improve public health, it’s important to investigate economic security, educational attainment, housing conditions, and the local environment. While direct causation can be difficult to define, many of these socioeconomic factors can influence the health of your entire community.

Let’s start with the basics.

What the Experts Say

The influence of socioeconomic factors on health and quality of life is well documented, and continues to be a highly active field of research.

what creates health?

In his report, Public Policy Frameworks for Improving Population Health, Alvin Tarlov addresses the five determinants of population health: Genes and Biology, Physical Environment, Clinical Care, Health Behaviors, and, (drumroll) Social and Economic Factors. According to Tarlov, Social and Economic Factors are a key indicator for determining population health. For local decision-makers, using social indicators to determine health is a great place to start, or a great place to add context to the data already coming from local health departments.

Using social and economic data, let’s compare the health of two cities in different parts of the United States: Boulder, Colorado and Athens, Georgia. We’ll look at both cities in terms of poverty, education, and unemployment.

Poverty and Health

First, we’ll focus directly on poverty and how it is related to community health. Poverty is both a cause and a consequence of poor health.

Poverty increases the chances of poor health and poor health, in turn, traps people in poverty. The cost of doctors’ fees, prescriptions, and transportation to reach a health care provider can be devastating for families living in poverty. Conversely, families with higher incomes can more easily purchase healthy foods, pay for preventative, annual, or emergency health services, and have better access to transportation.

The maps below shows areas across Boulder, CO (left) and Athens, GA (right) where there are a high proportion families living in poverty.

The chart below shows the income to poverty ratio compared in Boulder, CO and Athens, GA.

Income to Poverty Ratio

Unemployment and Health

Here we look more closely at a structural economic indicator of public health outcomes.

Job insecurity and lack of benefits associated with employment make residents more vulnerable to poor health. Unemployment may contribute to housing instability, unmet medical needs, and inability to purchase healthy foods. Additionally, health-harming stress can accompany the social and economic hardship caused by unemployment.

Employment Status_ Unemployed.png
unemployment

HealthyPeople.gov identifies the “availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods” as important examples of social determinants of health.

Education and Health

The quality of schools is another important social determinant of health. The school proficiency index, used here to indicate the quality of local schools, uses school-level performance data from 4th grade students on state exams to show which neighborhoods have high-performing or low-performing elementary schools. Values are percentile ranked and range from 0 to 100. The higher the score, and darker the color in the maps below, and the higher the school system quality is in the neighborhood.


Blow we can see the general level of educational attainment for adults in Boulder, CO and Athens, GA. Residents with more education are more likely to have jobs that provide health-promoting benefits such as health insurance, paid leave, and retirement. Conversely, people with less education are more likely to work in occupations with few benefits. Low-income residents who are struggling to access basic necessities, such as food and shelter, are unable to prioritize their education and long-term goals and are often stuck in a generational cycle of poverty.

Educational Attainment.png

How can this information help you determine health in your community?

Remember: There isn’t going to be one number, index, or way to answer “How healthy is my community?”

Determining community health is complicated.

It is going to require different types of information and local expertise. The best way to start answering this question is using data that already exists, combining that with local information, and comparing your city to similar cities.