It’s the nature of many Midwesterners to be healthy skeptics of jargon and buzz phrases. Being pragmatic and skeptical, we hear a phrase like “social determinants of health” about three times and wonder what is being cloaked behind jargon. What is being foisted upon hardworking taxpayers?
Because “social determinants of health” help our fire department, police officers, EMTs, and county leaders determine how to be fiscally responsible, we’re going to try to explain in “Layman’s terms. None of that industry [omitted BS] jargon nobody understands,” as Frank Shirley ordered Clark Griswold in National Lampoon’s Christmas Vacation.
Briefly, the phrase “social determinants of health” refers to the complicating factors that increase unhealthy behaviors and outcomes that cause people to visit the emergency department frequently, be diagnosed with chronic health conditions, develop substance use disorders, die young, end up in jail or need hospitalization for behavioral or mental health problems. All of the poor outcomes have more than one cause, and some of those causes have been missed or overlooked because professionals don’t see the conditions in which their client or patient was raised, lives, works, worships and attends school.
Food is a great place to start. Physicians (and teachers) don’t know if the client (or student) has enough food, let alone healthy food, the knowledge to discern healthy from unhealthy, or the transportation to get to healthy food. Deprivation harms brain development in young people leading to poor educational outcomes. When those kids become adults, they may not have the education to land a secure job nor the knowledge of what to eat to prevent obesity, diabetes, high blood pressure, heart conditions, even some cancers that have clear dietary causes. Too soon, they must rely upon the local ER to treat their conditions, often because they lack health insurance to go to regular office hours.
Consider this scenario. Crawfordsvillians living on a fixed income in Waterford Apartments often walk or scoot their mechanized wheelchairs to the nearby dollar store to purchase groceries and necessities. It’s the only place close by but those stores sell shelf-stable products, high in salt, fat, sugar or corn syrup, and processed grain. (Milk, eggs, cheese and frozen and canned veggies may be the exception). Most foods processed for an extended shelf life are linked to chronic conditions like diabetes, heart conditions, as well as colon cancer.
To complicate matters, low-income apartments often present a host of other low-grade risk factors to health and safety: poor ventilation, higher incidence of mold and dust trapped in carpets and walls that increase asthma, less access to outdoor parks for safe physical activity, higher rates of crime which deters outdoor activity, among others.
Furthermore, many of the residents lack the know-how and the resources to lobby local leaders for the following:
-A clinic within walking distance (or more accessible public transportation)
-Markets with fresh fruit (not just canned fruit in heavy syrup)
-Protein that isn’t steeped in sodium and other preservatives.
-Well-maintained and repaired apartments where carpeting doesn’t exhale years of cleaning products and spills.
-Parking and parks, well-lit roads, and outdoor monitoring so that whole blocks of cars are not robbed overnight.
Those are not the only social determinants of health because chronic health conditions are not the only problems. At-risk pregnancies, older adults aging-in-place, people with addiction, arrest records, who’ve served jail time or have been evicted, those who lack stable shelter, and those with mental or behavioral issues also have high recidivism rates. There isn’t enough space to unpack each scenario, but those are the problems for which our public servants look at social determinants of health.
The point is to reduce the cost we all share. Preventing multiple ER visits from uninsured patients reduces the cost of healthcare that hospitals redistribute to insured patients. Reducing arrests and jail time saves taxpayers. Treating substance use disorders reduces jail time and poor health outcomes. Providing maternity care for at-risk, uninsured pregnancies reduces long hospitalizations and costly NICU care. Preventative care saves lives and dollars. Triage care deals with acute symptoms and is built just to save a life at that moment. It serves a purpose but that purpose lacks forward thinking.
Harvard’s Global Health Education and Learning Incubator noted that “if we intervene and address (or work to change) determinants at the distal level, they can have a potentially greater impact on population health than simply focusing on individual behaviors, attitudes, or biological factors.”
As research shows, poverty contributes to a higher likelihood of heart disease. If we as a community deal with poverty, as well as a robust ecology of groceries, transportation options, preventative health care, community education, and places for physical activity, as well as fair paying jobs and insurance coverage, we will save lives and see a robust return on our investment fiscally.