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Social Determinants of Health

In America, many of us benefit from modern medical advances to address significant public health disparities. We only need to look back to 2021 or so to see just how quickly our country received powerful vaccines that successfully countered the effects of COVID-19 for millions of people. The speed at which the vaccine was developed was stunning.

If we wish to go back even further, we can look at the advances in medicines over the past forty years that helped to make HIV and AIDS go from a certain death sentence to a condition that people can live with for many years. The wonders of modern science never cease to amaze! But, while many Americans can reap a benefit of this work, many cannot.

For millions of Americans, quality healthcare remains out of reach at least partially due to what’s known as Social Determinants of Health or SDH. The CDC has been studying these determinants and defines them in the following way:

“Social determinants of health (SDH) are the complex, integrated, and overlapping social structures and economic systems that include the social environment, physical environment, and health services; structural and societal factors that are responsible for most health inequities. SDH are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices.”

The World Health Organization (WHO) has also addressed SDH by saying that “in countries at all levels of income, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health.” In fact, the WHO points out that “there is a difference of 18 years of life expectancy between high- and low- income countries.”

Social determinants of health can include a variety of items including topics such as food insecurity, housing inequality, and access to quality education. But perhaps two of the most prolific determinants are low income and racial and sexual/gender discrimination.

Low income, for instance, can certainly impact the ability of a person to acquire access to decent healthcare, which could cause significant health problems for those individuals.

For example, according to a document on SDH composed by the CDC, a study found that heterosexual males and females living below the federal poverty level in certain U.S. cities were more likely to acquire HIV than their counterparts who were not living below the poverty line.

Another determinant that can greatly impact health is experiencing discrimination. In 2021, the Director of the Centers for Disease Control, Dr. Rochelle P. Walensky, said, “What we know is this: racism is a serious public health threat that directly affects the well-being of millions of Americans.”

And according to Walensky’s agency, the CDC, the United States had just over 1 million people living with HIV in 2019. Of those, around 479,000 cases – or 40% - were comprised of only Black people.

Further, the Federal Government’s National HIV AIDS Strategy (NHAS) points out the “sexual and gender minorities have lower levels of health insurance and access to regular health care compared to their heterosexual counterparts.” And according to Harvard University, one-fifth of LGBTQ adults report that “they have avoided seeking medical care out of fear of discrimination…”

What can be done about the disparities in these social determinants? That’s a good question as it will likely take a lot of time and effort to address. And while it’s not up to one governmental agency like the CDC to single-handedly solve this problem, that agency has outlined its plan to address them by promising to, among other things, “identify evidence, tools, and resources to enhance communication about policies that affect SDH with policy makers and other stakeholders.”

Hopefully, we will one day see positive change when it comes to addressing the social determinants of health that will ultimately lead to a level the playing field for all Americans – and for individuals the world over.


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