Social determinants of health – Marilyn R. Gardner

“Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” from Genes Don’t Cause Racical Disparities, Society Does

An article from The Atlantic, as quoted above, says this “Researchers are looking in the wrong place: White people live longer not because of their DNA but because of inequality.”

It’s NOT about race people!

Basically, billions of dollars have gone into funding studies that look at race as a basis for health disparities when, in fact, it is far more about living conditions. For years conventional wisdom has argued that there is really nothing we can do about these health disparities, because it’s really about biology. But a review of the literature showed none of that. Jay Kaufman, lead author of the study “The Contribution of Genomic Research to Explaining Racial Disparities in Cardiovascular Disease: A Systematic Review” says this:

“If you show that this is a predisposition that is genetically determined—black people just have this gene, there’s nothing we can do about it, this is just nature—then society is completely absolved. We don’t have any responsibility to solve this problem….If you show that it is because of racism and injustice and people’s living conditions, well, then, there is some responsibility and we have to do something about this.”

One of the things that we pay a lot of attention to in public health is something called the “social determinants of health.” The social determinants of health are defined as “the conditions in which people are born, grow, live, work and age, including the health system.” This takes into account not only your genetic code, but also your zip code.

Here is an example: Four years ago I did some consulting work in Washington state for community health workers. One of the classes that I held was in a public housing space in Tacoma, Washington. The space was beautiful. It was a ‘mixed use housing’ area which means that some people owned their homes while others rented. There was a beautiful playground, a clinic, an assisted living space, and a school down the road. But when I asked someone who lived there where residents purchased food, she looked at me and said “It takes three different bus rides to get to a grocery store.” This is what we call a “food desert.” Right across the street you could buy 1500 calories of junk for a dollar and yet it took a major part of the day to buy good food.

A researcher who goes into that community, a community largely made up of “people of color,” may find high rates of heart disease. But it has little to do with the color of their skin, and perhaps a lot to do with the fact that healthy food is so far away.

All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition. It also turns out that most of “those people” end up being people of color.

Where we live matters!

In the PBS series “Is Inequality Making us Sick?” questions about the social determinants of health are asked. Like the article in The Atlantic, the answers are troubling, because it’s a lot more to do with our neighborhoods and zip codes than our genetic codes. And that means we can do something about it.

All of this is best summed up in this statement:

“When it comes to why many black people die earlier than white people in the U.S., Kaufman and his colleagues show we’ve been looking for answers in the wrong places: We shouldn’t be looking in the twists of the double helix, but the grinding inequality of the environment.”

But, like almost everything, it is far easier to write about it, then to take concrete action and actually do something about it.

Is inequality making us sick?

This is the telling question asked in a video series produced by California Newsreel and shown by PBS a couple of years ago. As a public health nurse I use this series often to draw attention to the wide gap between people and neighborhoods that exists when it comes to health. It seems that our zip codes have more to do with our health than our genetic code. This is a serious indictment. While we hear about the “widening gaps” between rich and poor and the problem with distribution of wealth, rarely does anyone drill it down to diseases people get, life span, and all the other factors that go into overall wellness.

As debates on health and healthcare continue it makes sense to focus on these most basic things, termed in the public health world as the “social determinants of health“. The World Health Organization explains these determinants this way: “the conditions in which people are born, grow, live, work and age, including the health system”. Paying attention to these determinants would change outcomes to a degree that any costs incurred would be covered through reduced rates of diabetes, high blood pressure, heart disease and the list could go on and on. Transforming neighborhoods does as much or more to increase health and wellness as diet and exercise.

Nancy Krieger, an epidemiologist from Harvard School of Public Health says this: “We interact constantly with the world in which we are engaged. That’s the way in which the biology actually happens. We carry our history in our bodies, how could we not?”

The question becomes how can we, how can I, be a part of changing the communities where we live world-wide? While I believe governments, both state and federal, can help with policies, they aren’t the ones who can create communities that care. Only people who live within those communities have the capacity to do that. So as we bicker about politics and point fingers we’re wasting a lot of time. Time that could be spent in helping to transform.

Take a look at the introduction to the series and see what you think.

UNNATURAL CAUSES | About the series . Video clips | CALIFORNIA NEWSREEL.