By: Sarah Wang
Health means more than health care. Health is affected by a person’s environment, opportunities, and experiences. While health care is an essential component of health, we know that there is a broad range of social, economic, and environmental factors that can support or hinder health outcomes. Factors such as housing, family circumstances, education, and neighborhood conditions and safety play an important role. In fact, 40% of life expectancy and health status is attributable to social and economic factors, 30% to health behaviors, and 10% to the physical environment. Just 20% of life expectancy and health status is attributable to clinical care.
In many cases, it is not just how one lives that can affect health, but where one lives. For example, people living in low socioeconomic status neighborhoods may not have access to healthy foods or safe spaces to exercise and play. Many people experience multiple negative social determinants of health. Population health concerns are created when certain communities are disproportionately affected.
To move away from taking a symptom-based approach to healthcare, it is important to address root causes of poor health. Social determinants complicate the ability of healthcare providers to address patients’ health needs, impacting the scope and intensity of services needed to treat patients. For example, a patient with hypertension who is living in poverty and does not have stable housing is very different from a patient with hypertension without these social concerns. Although most physicians today recognize the importance of addressing a patient’s physical environment and social condition, many still report that they lack the confidence, resources, or time to do so. Health interventions alone — without addressing racism, economic disparities and other social determinants — will not reduce the disparities in health outcomes apparent in our communities.
One group of providers at the forefront of tackling social determinants of health are community health centers. They have a unique approach to care, combining medical and social approaches to care for families and communities. Health centers have been providing primary care and other comprehensive services to the most vulnerable populations in the US since the 1960s, serving those with limited access to health care. These include low-income populations, the uninsured, individuals experiencing homelessness, individuals with limited English proficiency, and migrant and seasonal farm workers. Today, health centers serve 1 in 13 people in the US, and 1 in 10 children, according to the US Department of Health and Human Services.
Addressing the social determinants of health is in the “DNA” of community health centers. Health centers are rooted deeply in their communities, and have a breadth of knowledge of community needs. In addition to providing comprehensive primary care services, they are also addressing social determinants through a wide range of activities. These activities may include offering parenting classes, providing health education, nutrition and healthy cooking workshops, providing job skills training, and ensuring access to safe and affordable housing. These services help to empower community residents to live healthier lifestyles, and improve community conditions. Finally, health centers form partnerships with other community organizations that are addressing the social determinants, such as local health departments.
Many of our community members are facing significant preventive care needs, poor transportation options, unsafe housing, chronic stressors, and other triggers of unhealthy outcomes. Bold, holistic approaches are needed to create the community conditions in which lasting change can take root. Only then can achieve better health outcomes in generations to come.
Sarah Wang is a Project Coordinator at the Community Clinic Consortium, a partner of the Solano Coalition for Better Health