Social Determinants of Health (SDOH) are social and economic factors that influence individual and group differences in health status. These factors result from historical forms of oppression and can lead to negative health outcomes. Instead of relying on symptoms or genetics, social determinants of health explain underlying causes of disease in the context of environments largely outside of personal control. Social factors can include anything from income and education to one’s neighborhood and the proximity to violence. In fact, one’s environment matters so much that an individual’s zip code can be more predictive of health than their genetic code!
Through interconnecting social factors, some people in the United States have a disproportionate burden of poorer health outcomes. For example, the CDC states that Type 2 Diabetes disproportionately affects Black and Hispanic people in the United States, but the causality has nothing to do with genetics. People are more likely to develop diabetes if they consume diets that primarily consist of fast food as they are high in saturated fat and processed ingredients. There is a large density of fast-food restaurants in urban settings, and these areas often have lower socioeconomic statuses. Due to past residential policies and actions such as redlining, Black and Hispanic people disproportionately reside in these low-income urban areas. According to the National Institute of Health, the lack of healthy meals increases the likelihood of developing obesity and hypertension, which are two of the most important risk factors in the onset of diabetes. Thus, certain populations will have different health outcomes as a result of environment, not genetics.
Social determinants mold health from a young age, but the environment surrounding older adults also impacts wellness and aging experiences. Residential neighborhoods are critical spaces for older adults because they tend to spend more time at home. This is why spaces that don’t satisfy their needs can significantly impact their health. Neighborhoods are heavily segregated by socioeconomic status, and older adults in low-income areas have lower quality medical care, fewer grocery stores, and weaker support networks. Something as simple as the absence of sidewalks can decrease exercise, mobility, and independence for an older adult. All of these factors contribute to poorer health consequences.
In addition, finances are another social determinant that can act as a significant barrier for the elderly. Unfortunately, in today’s society, a substantial portion of the aging population lives on a limited income. More than half of all adults 65 years and older make less than $25,601 in annual income, which is 2.3 times less than the average U.S. annual income. This financial insecurity can lead to poor diet, limited transportation, and the inability to move to a better neighborhood.
The factors that affect the aging population’s access to care cannot exist in separation; rather, the social determinants of health have a complex and interconnected relationship. If an older adult that lacks access to a sidewalk is also low-income, their ability to obtain proper care will be exponentially impacted. If that same older adult has a poor diet and no means or funds for transportation, they cannot readily buy healthier food, which tends to be more expensive. If they cannot access the food they need, they will continue to become unhealthier and develop more medical conditions. Since medical care in lower-income areas is often of poorer quality, and these individuals cannot afford to move out of their neighborhoods, they are stuck without accessible means to improve their declining health. Without intervention, aging populations’ social determinants of health will continue to feed into the vicious cycle of disproportionate inequity.
The intricate feedback loops stemming from social determinants of health can help us draw an important conclusion: in order to improve the wellbeing of older adults, we must first focus on the environment in which they live and the lives which they have led. Detrimental health outcomes can be prevented with interventions and programs, and Intus Care believes that taking these considerations into the realm of clinical care could mitigate disproportionate health inequities.
Recently, a Change Healthcare survey found that 80% of long-term care organizations believe that addressing their members’ social determinants of health is crucial to improving programs. In order to achieve health equity, there must be a conscious effort by those of us in geriatric care to weave social determinants into the fabric of our community.
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