Social Determinants of Health: Social and Community Context

To date, we've explored a full range of social determinants of health (SDOH) in our blog series, including how our access to quality healthcare affects our overall well-being, the effect our neighborhoods and built environments have on our physical and mental health, how our ability to access an equitable and quality education transforms our lives and experiences, as well as how economic stability (or the lack of it) directly impacts our health. Today, we're wrapping up the series by taking a look at the social factors that affect our health, including social support, community cohesion, and discrimination.

Unpacking Social Determinants: Social and Community Context  

There are a variety of social factors and conditions within our communities that significantly influence our health and well-being, which the World Health Organization refers to as social inclusion and non-discrimination. This dimension of the SDOH includes the quality and nature of our relationships with family, friends, and peers, the level of social support available, the amount of community engagement we experience, and the clear presence of social support networks. It also includes broader societal issues such as discrimination, stigma, religion, and cultural norms that affect how we experience and access healthcare.

For example, meet John, a 16-year-old male living with HIV in New York City, sharing a small apartment with his three siblings and mother, who also has HIV. Their home, filled with love and struggle, does not reflect a broader community grappling with stigma and limited resources. Here, the social dynamics and the strength of community bonds play crucial roles in shaping health outcomes, providing either a support system or a series of hurdles. 

When John was outed at school, it was a big deal; he was bullied, and despite his loving home, he felt isolated and lonely. The school nurse suggested some online resources, such as Healthy Sex, HIV.gov, CDC, and Stop the Virus, and he found an organization referred to as the GMHC (Gay Men's Health Crisis). 

The school nurse took the time to address more than just John's basic medical needs. By confronting stigma head-on and fostering health education, his school nurse and the GMHC created a supportive environment for the entire family by connecting them to vital community resources and empowering them to manage their health with resilience and hope. For John, this meant finding a safe space to discuss his condition and access the care he needed. For his mother and siblings, it meant receiving support that acknowledged their collective struggles and strengths. For John's school nurse, it means their student and patient can thrive in an otherwise difficult social environment.

The Impact of Social and Community Factors on Health  

A doctor visit or even a basic diagnostic test can be a life-changing choice. In the US, people younger than 65 with private insurance comprise 64.4%, and people younger than 65 with public insurance comprise 28.6%. This leaves a reported 25 million uninsured (of all ages), according to the CDC's 2023 National Health Interview Survey.

The challenge is that for those earning 100-200% of the Federal Poverty Line (FPL), being insured is costly: $15,060 for one person and $5,380 for each additional individual. Unsurprisingly, many Americans have to focus on more immediate needs like paying for housing, buying groceries, and traveling to work/school instead of investing in insurance to maintain their health. 

Let's take a look at Michelle, a 20-year-old Latinx student with public insurance who's feeling the weight of the world on her shoulders. Recently diagnosed with metabolic syndrome, she's struggled to manage the cost of her care, educational demands, and part-time work on her own in her apartment near campus. Initially, Michelle felt isolated and overwhelmed by the idea of needing to return home to the small town where her family still resided. However, recognizing her need for emotional and financial support, she decided to move back home. The transition brought her into the embrace of her family's care, enabling her to navigate her health journey with newfound resilience and far less stress. With the support of her social network and the stability provided by public insurance, Michelle found a way to balance self-care with her studies, illustrating the critical role of social and community factors in achieving optimal health outcomes. 

Health providers can take several steps to help patients like Michelle, such as: 

1. Offering assistance navigating public insurance options: Helping patients understand their coverage, ensuring they know all available benefits, and assisting with the paperwork required to maintain their coverage significantly impacts patient health outcomes.
2. Making sure they know about prescription assistance programs: Offered by pharmaceutical companies, non-profits, and government agencies, these programs can reduce or eliminate out-of-pocket costs for necessary medications and improve a patient's ability to comply with treatment recommendations.
3. Tracking and sharing information about community resources:  Learn about and share information about local health clinics, support groups, and educational workshops that provide additional support. For example, finding a local clinic that offers nutritional counseling and stress management classes could be invaluable for Michelle. 
4. Providing telehealth options: For patients with transportation limitations or hectic schedules (e.g., school and work, multiple jobs, no childcare). This flexibility provides for more consistent care and follow-up. 

Understanding Disparities in Social and Community Contexts  

In the vibrant tapestry of our lives, where we live, work, and connect with others profoundly shapes our health.  Addressing health disparities requires concerted efforts from more than just individuals; it requires working with communities, health providers, and volunteers. Fostering collaborative partnerships and increasing access to resources such as healthcare facilities, educational programs, and social services are crucial. To ensure access, health providers must recognize that they are vital advocates in developing equitable healthcare policies to provide culturally competent care to underserved populations.  

For example, a spark of hope ignited in a tight-knit farming rural community where healthcare access has been a significant challenge, with the nearest medical practice 35 miles away. Just fifteen minutes from the heart of a small community, an osteopathic medical school became the cradle for a grassroots initiative called "Health Hub." Determined to make a difference, local medical students transformed an abandoned building into a vibrant one-stop resource center. Health Hub offers free medical screenings, health education workshops, and referrals to essential social services, providing a lifeline for underserved residents grappling with financial constraints and transportation barriers. Staffed by passionate medical students, faculty, and volunteers and bolstered by support from local businesses, this initiative brought healthcare within reach. Through collaborative partnerships and community engagement, Health Hub delivers critical health services and fosters a sense of belonging and solidarity, empowering residents to take charge of their health and well-being in ways they had never imagined possible. 

Community involvement is essential to addressing systemic barriers and creating pathways to better health outcomes, particularly in the US, where so many are underinsured and undertreated. Grassroots initiatives and local advocacy efforts raise awareness, build supportive networks, and promote healthy living environments. Volunteers contribute to the overall well-being of their communities by offering their time, skills, and empathy through direct service in clinics or community events that promote health education and access. 

Targeting Social and Community Factors  

Social Determinants of Health (SDOH) are pivotal in shaping our well-being, no matter where we live. Social services and support programs are crucial in addressing these determinants by providing essential resources and assistance to needy individuals and families. These programs can be city, state, or federally sponsored, but they only sustain and succeed with the engagement and support of the population they serve.  

As health providers, the CDC offers campaign inspiration and ideas that can be implemented by one or a group of providers. Take, for example, BIPOC maternal-fetal mortality, providers, and families. As students, health advocates, or community advocates, resources like the CDC are available to empower communities to be and stay healthy.  

In addition, regional organizations like the March of Dimes and Planned Parenthood and grassroots programs like the Stork's Nest program provide underserved mothers with comprehensive prenatal care, childbirth education, and postpartum support. Through community outreach events and partnerships with local clinics, their campaign delivers crucial healthcare services and fosters a supportive environment that empowers women with essential knowledge and resources.  

Addressing issues such as poverty, education, and healthcare access within the community through social connections and health outcomes demonstrates the transformative potential of public health campaigns and healthcare cooperation in addressing societal health challenges. Whether locally or federally sponsored, adequate social services and support programs rely on community engagement to succeed, underscoring individuals' civic responsibility in sustaining these vital initiatives. 

Conclusion 

Throughout this series, we've delved into critical factors such as access to healthcare, neighborhood environments, educational opportunities, economic stability, and now, hidden social factors, including social support, community cohesion, and discrimination, that affect us. By understanding how these factors impact our well-being, we've embarked on a journey to foster healthier, more equitable futures.  By recognizing the interconnected nature of SDOH, we can work towards creating a better, equitable society where everyone has the resources and support they need to thrive. Through ongoing dialogue, advocacy, and action, we can address systemic inequalities and strive towards a future where health and well-being are genuinely accessible to everyone. 

References 

• ASPE. https://aspe.hhs.gov/about 
• Cohen RA, Briones EM, Martinez ME, Division of Health Interview Statistics, National Center for Health Statistics. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2023.; 2024. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202406.pdf 
• Featured health communication campaigns. Centers for Disease Control and Prevention. Published May 8, 2023. https://www.cdc.gov/healthcommunication/campaigns/index.html 
• FastStats. Health Insurance Coverage. https://www.cdc.gov/nchs/fastats/health-insurance.htm 
• Poverty guidelines. ASPE. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines