The social determinants of health are the underlying conditions of health—the aspects of one’s health which cannot be seen in a doctor’s examination room, although they are all of the factors which lead up to that point. They are the housing conditions one lives in, whether in a slum or an upscale suburban house, which affect their breathing conditions and the quality of their lungs. They are the education system, which either gives students opportunities to succeed or deprives students of understanding their potential, determining whether a person can have enough economic mobility to rise above their prior circumstances. They are also unchangeable factors which have determined the path of people’s livelihoods for centuries—such as race.
Current events in the U.S., most recently, the heinous killing of George Floyd, have shed light on the social determinants of health, whether or not we know it to be so. When people think of public health, they often think of smoking education ads, opioids, or pandemics, and public health does encompass all of these things. But public health is beyond vaccines and antibiotics and death; it is also the biases and racist beliefs embedded in minds, because these determine decisions, and these decisions alter lives. On June 12th 2020, Mayor Marty Walsh declared racism a public health crisis in Boston, with historic and systemic racism impacting COVID-19 cases and reaching well beyond the pandemic. Moreover, the effects of racism on health outcomes can be seen across the nation: maternal mortality rates are higher among African American women in labor rooms. Additionally, Black people are three times as likely to be killed by police than their white peers, although they are 1.3 times more likely to be unarmed. According to a paper co-authored by Professor David R. Williams—chair of the Department of Social and Behavioral Sciences at the Harvard T.H. Chan School of Public Health and the leading social scientist behind the Everyday Discrimination Scale—racism can also affect health through chronic stress even in experiences without conscious, prejudicial intent, in turn contributing to racial and ethnic disparities in health.
The threat of racism in public health is not only severe because it is all-pervading, but because it is often implicit. We do not see the social determinants of health, but we can see their physical manifestations: disproportionate mortality rates, inequality due to gerrymandering policies, the targeted locations of food deserts, for example. Racism has systemic and historical roots, so its solution will inevitably be complex.
Educational institutions can play a critical role in changing how biases pervade thought, research, and conversations in classrooms. Addressing the concerns of faculty who are a part of minority groups, showcasing their research, and examining how racism could be getting in the way of them getting well-deserved positions of leadership is a place to start. It is on policymakers to creatively tackle the underlying factors which contribute to these disparities—housing segregation, school funding, and incarceration, for example. Social determinants of health can be at grocery stores, in rotations at hospitals, in laboratories, or in economic models. Addressing police brutality through protests, petitions, and policies is crucial, and so is addressing all of the other social determinants which are affecting the well-being of Black people in the U.S. As individuals, we educate; as a community, we demand action; and as a society, we must continue to push for better policies.
To learn more about health, racial disparities, and social determinants, feel free to check out the following GHELI resources: