Social Determinants of Health

"The United States spends more on health care than any other nation in the world,

yet it ranks poorly on nearly every measure of health status."

Dr. Steven Schroeder

Factors that determine health are referred to as the Social Determinants of Health. These determinants can be grouped into 5 general categories:

1. Social Circumstances include the conditions in which people live, work and play. Health is greatly influenced by our education, employment, income, housing, neighborhood, social support, and food choices. Education may well play the largest role in health and longevity; poverty is another strong health predictor. Social Circumstances account for 15% of health outcomes.

2. Environment includes the settings and situations surrounding individuals such as natural and man made environment, exposure to toxic substances or hazards, worksites and neighborhood surroundings. The Commission to Build a Healthier America claims that our zip codes have a greater impact on our health than our genetic code! The environment generally accounts for 5% of health outcomes.

3. Heredity consists of biological and genetic factors including age, gender, family history, and ethnic background. Heredity and genetics account for approximately 30% of health outcomes. Very few deaths are attributed purely to genetics (2%) although many disorders (diabetes, cardiovascular disease, cancer) have some genetic component.

4. Personal Behavior is credited to have the greatest influence over our health – an astounding 40%. In a 2002 article in Health Affairs, McGinnis, states: "The daily choices we make with respect to diet, physical activity, and sex; the substance abuse and addictions to which we fall prey; our approach to safety; and our coping strategies in confronting stress are all important determinants of health."

5. Access to affordable, high quality health services accounts for 10% of health outcomes. Montana's 15 community health clinics have utilized over $182 million in federal grants since 1985 to provide access to medical, dental and mental health services at reduced cost to people living below 200% of the Federal Poverty line. Barriers to accessing health services include lack of insurance, high cost, and lack of availability.

It is important to realize the interrelationship of these factors. Interventions that address multiple health determinants are likely to be the most effective.

Health clinics that wish to expand their approach to disease prevention and better health outcomes should survey community to determine which of these categories would be most likely to improve the health of their community.  For example, if a community lacks clean drinking water, this issue may be the best initial intervention (environment).  A community that experiences a high rate of smoking or obesity would be wise to target these behaviors (personal behavior).

This toolkit focuses on the importance of education (soical circumstances).  Communities that sufferfrom low educational achievement, high unemployment, and large pockets of poverty may find these education interventions helpful in affecting the health of their population.