What are Social Determinants of Health, and Why are they Stacked Against Minorities?

April is National Minority Health Month. To understand the inequality of health in minority communities, we look at how social determinants affect health.

The age-old health adage “an apple a day keeps the doctor away,” is actually rooted in undeniable wisdom. Health, at its core, represents more than a mere absence of disease. Its cultivation begins at home, not at the doctor’s office.

Achieving and maintaining good health requires individuals to make salubrious choices. However, one can only choose from the options available to them and often that is determined by location, finances, daily responsibilities, etc. Subsequently, community health requires fostering the conditions that not only allow but encourage individuals to make healthy choices in their daily lives.

In the healthcare research community, the condition of our homes, our schools, our workplaces, our neighborhoods, and our places of worship all contribute our well-being, and are referred to as the “social determinants of health.” These social determinants explain, in large part, why some Americans are healthier than others.

Understanding Social Determinants of Health

Healthy People 2020 defines social determinants of health as the “conditions in the social, physical, and economic environment in which people are born, live, work, and age.”

An individual’s “social environment” consists of the socio-cultural institutions, norms, patterns, beliefs, and processes that are part of everyday life. Interactions with friends, family or co-workers; language barriers, political leanings, or religious beliefs; and socioeconomic factors such as poverty, crime, employment, or quality of education all contribute to one’s social environment.

The “physical environment” refers to the spaces, both natural and built, in which an individual conducts his or her affairs. The natural elements (plants, air quality, weather, topography) and built elements (buildings, playgrounds, transportation systems) that individuals encounter on a regular basis can either encourage health by facilitating access to health care providers and nutritional foods, or impair health by exposing individuals to toxic substances, physical hazards, and stress-producing factors like noise pollution and excessive traffic.

Unbalanced Health Outcomes for Minority Communities

In 1991, the National People of Color Environmental Leadership Summit declared that the environmental justice movement represented “the confluence of three of America’s greatest challenges: the struggle against racism and poverty; the effort to preserve and improve the environment; and the compelling need to shift social institutions from class division and environmental depletion to social unity and global sustainability.” Lamentably, this assessment remains as precise today as it was decades ago.

One example that evidence suggests is that African-Americans have the highest risk of developing Alzheimer’s, yet less than 5% of participants in Alzheimer’s-related clinical trials are drawn from this demographic. Similarly, the prevalence of Alzheimer’s among Latino-Americans continues to rise, but this demographic accounts for just 1% of participants in clinical trials.

Such staggering under-representation creates a variety of problems, both for sufferers of Alzheimer’s and for their caregivers. According to data from the Centers for Medicare & Medicaid Services, 34.2% of hospitalizations of Latino-American Alzheimer’s patients are preventable, as are 28.8% of hospitalizations of African-American patients. For white Americans, the figure sits at 23.7%, just 0.9% above the overall target for the year 2020.

Pinpointing the cause of these disparities is difficult, but there is no question that social determinants are a contributing factor. Latino-Americans frequently cite the language barrier as a primary reason for why they do not participate in clinical trials. Further, Karen Lincoln, an associate professor at the USC Suzanne Dworak-Peck School of Social Work, explains that “African-Americans still have a profound mistrust of medical research,” making it difficult for researchers to secure African-American trial participants.

Diagnosing and adjusting the social determinants of health that produce detrimental effects in minority communities is a challenging endeavor, but it is not impossible. With dedicated and forward-thinking work, the health care research community — and society at large — can make progress on these issues and cultivate health across demographic boundaries.

Every American deserves an equal opportunity to make choices that lead to good health. In order to realize this, we must understand what social determinants are, where they tend to have the most significant and detrimental effects on health and health care, and what we can begin to do to address and improve their impact.