Black History Month: Combating Health Inequalities by Addressing Social Determinants | Health News from the Healthiest Communities
The theme for this year’s Black History Month has been Black health and well-being – an important issue that impacts the future and prosperity of the entire nation, and strikes an even deeper chord. salient as we continue to navigate our way through the COVID-19 pandemic. But while I am grateful and welcome any opportunity to focus on health, wellness and disease prevention, we must also focus on these issues throughout the year and take advantage opportunity to redefine how we think about improving our health.
In the United States, our health is closely tied to the conditions in which we live, such as our neighborhood, access to green spaces for physical activity, whether we live in a “food desert” or have access to a healthy diets, exposure to environmental toxins, the ability to access health care, and the quality of care we receive. Collectively, these types of health influencing agents are known as the social determinants of health, and they are often stratified by race.
The World Health Organization defines the social determinants of health as “the conditions in which people are born, grow, live, work and age”, stating that “these circumstances are shaped by the distribution of money, power and resources at global, national and local levels”. , themselves influenced by political choices.
Indeed, these modifiable factors are systematic, facilitated by policies, and result in unequal opportunities and living conditions for many people in our communities. They are also primarily responsible for the health inequalities experienced by communities that have historically faced discrimination or marginalization. To that end, racism is increasingly recognized in the United States as a root cause of health inequities and has been declared a public health crisis.
During the pandemic, several social determinants explain why many people of color have been at higher risk of contracting COVID-19 or more likely to be hospitalized and die from it. For example, factors such as whether you have a job that requires high contact with the public and co-workers (e.g. transit workers, waiters, plant or factory workers) or whether you have a job that allows you to work from home affects your risk of exposure to COVID -19, as does whether you own a car or depend on public transport, the number of people and rooms in your household, and if there is space to self-isolate and quarantine after exposure. Likewise, whether your neighborhood has access to emergency care and high-quality health care can impact the type of medical treatment you receive after contracting COVID-19.
Social determinants are also directly associated with conditions such as obesity and diabetes that occur disproportionately in people of color and are linked to increased risks of COVID-19. In fact, given that our country’s history of racism and institutional bias has influenced nearly every facet of life, including health, it’s no surprise that black people in the United States have experienced patterns long-standing and pervasive disparity in a multitude of health problems, such as maternal and child mortality, asthma, cancer, HIV/AIDS, hypertension, stroke and heart disease.
But that doesn’t have to be the case: while much attention has been paid to medical solutions, we need to tackle the social determinants of health and their root causes head-on to properly address these types of health and well-being. The public needs to be aware of the social conditions that fuel health disparities and that they are systemic and require solutions that go beyond health care. We need to educate our communities and legislators that every political decision has an impact on health, whether short or long term. Addressing these issues can help us achieve the ultimate goal of health prevention for all diseases in which health disparities exist.
Diabetes offers a perfect model to tackle a major killer within the black population and demonstrate the role of the social determinants of health. More than 37 million Americans (about one in 10) have diabetes and more than 90 million American adults are prediabetic. In 2018, black/African American adults were 60% more likely to be diagnosed with diabetes than white people. Meanwhile, type 2 diabetes – the most common form of the disease – has been linked to factors such as income level, a person’s access to green spaces, early nutrition and retail environment.
More recently, as deaths from diabetes in the United States increased, the National Clinical Care Commission sent a report to Congress on the use of federal programs to prevent and control the diabetes crisis. The executive summary of the report states that “the Commission approached its charge through the prism of a socio-ecological and broader model of chronic care. It was clear that diabetes in the United States cannot simply be viewed as a medical or health care issue, but must also be treated as a societal issue that affects many areas including food, housing, trade, transport and the environment. The commission’s recommendations include solutions related to the social determinants of health, such as strengthening and improving nutritional support programs, increasing breastfeeding rates and expanding housing options.
There are ways to address the social determinants of health by changing our social, economic and political systems and dynamics. But we cannot solve problems that we refuse to face and understand. To address these crucial factors, it is necessary to confront racism and classism – and their long-term, intentional and unintentional, effects on health, however uncomfortable we may be. It’s easier said than done, but working with leaders and decision makers from all sectors – not just the medical community, but also those in housing, education, criminal justice, finance and more – it is possible to formulate action plans and achieve achievable goals to reduce systemic loads one year at a time.
As we celebrate Black History Month in February, let’s not lose sight of the work at hand. We still have 11 months of the year and generations to work together to become a healthier, more equitable nation in which every American has the opportunity to achieve optimal health.