Social Determinants of Health: Can We Address Equity with Communications?

Both having good health and coping with challenges to health are a journey. Inadequate resources make a successful journey harder. At an individual level, lack of personal resources such as income and knowledge, limit an individual’s ability to follow optimal paths to health and vice versa. At a macro level, our society has a finite amount of resources—both monetary and service‐related—that realistically will not provide everything to everyone. We do not “naturally” think about health in terms of social factors. However, our health is significantly affected by our homes, jobs, and schools. The social determinants of health are the economic and social conditions—and their distribution among the population – that influence individual and group differences in health status.
 
In 2010, the U.S. Department of Health and Human Services unveiled Healthy People 2020, the nation’s 10-year goals and objectives for health promotion and disease prevention. The Healthy People initiative is grounded in the principle that setting national objectives and monitoring progress can motivate action. Healthy People 2020 highlights the importance of addressing the social determinants of health by including “Create social and physical environments that promote good health for all” as one of the four overarching goals for the decade. This emphasis is shared by the World Health Organization, whose Commission on Social Determinants of Health in 2008 published the report, Closing the gap in a generation: Health equity through action on the social determinants of health.
 
We generally recognize five determinants of health of a population:
  1. Biology and genetics (e.g., gender).
  2. Individual behavior (e.g., alcohol or injection drug-use, unprotected sex, smoking).
  3. Social environment (e.g., income, education level, marital status).
  4. Physical environment (e.g., place of residence, population density, built environment).
  5. Health services (e.g., access to and quality of care, insurance coverage).
 
Although we do not know the exact impact of each of these five determinants of population health, in theory, social environment, physical environment, and health services (which combined make up social determinants of health) represent 50 percent of the factors that influence population health. This leaves us subject to our choices and circumstances for safe and affordable housing, access to quality education and job training, public safety, health services, and availability of healthy foods. These factors and social patterning of health, disease, and illness often plague individuals seeking to break the vicious cycle of barriers that prohibit them from making positive lifestyle changes. These are key factors in health inequity or health disparity—a particular type of difference in health (or in the determinants of health that could be shaped by policies)—in which disadvantaged social groups systematically experience worse health or more health risks than do more advantaged social groups.
 
As a social marketing professional who has developed and implemented several health campaigns, I believe communicators must take into consideration and address each of the determinants when developing awareness and education programs; especially when we seek to reach and encourage action among special populations. For example, racial and ethnic minorities, the elderly, women, children, individuals with disabilities and LGBTQ populations. It is these populations who are often heavily impacted and in the greatest need of such health messaging. Yet, it is also the same populations who are often “stuck” in a vicious cycle of barriers that prohibit them from making positive lifestyle changes.
 
Social determinants challenge us to take into consideration a person’s/or population’s environment and circumstances to appropriately develop messages and strategies that resonate, reach the audience at the right time and in the right place, and that are realistic – meaning that audience circumstances truly allow them to act in the desired manner. Behavior change is difficult and individuals cannot do it themselves without support. Behavior change communication programs are designed to bring about behaviors that will improve health status and related long-term outcomes. Such programs are key to providing the support structure that help people make the necessary health changes in their lives. Effective action to address the social determinants of health requires having sufficient knowledge of the mechanisms influencing health inequities, and adopting a conceptual framework that not only clarifies the relationship between social determinants and health inequities, but also helps to identify entry points for intervention.
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