Are medications the only thing that affects your health? Let's learn about social determinants (Social Determinants of Health - SDOH)

Have you ever wondered why some people are healthier than others? Sometimes we think that if we take good medicine and see a doctor, we can stay away from diseases. But in reality, there are a lot of other factors that affect our health, which we may not pay much attention to in our daily lives, but are very important. That's what we call the Social Determinants of Health (SDOH).

What are these social determinants of health (SDOH)?

Simply put, this is how your personal, social, and environmental factors affect your health and well-being. These are non-medical factors. That means things like your income, your level of education, the type of home you live in, and the amenities your extended family has. You may not want to talk to your doctor about these things because you don't think they're related to your health.

But, research has found that these social determinants of health (SDOH) are not just related to your health, they can actually determine your health. That is, they affect your risk of developing certain diseases, the medical care you receive, and how well you feel from day to day.

Imagine, if you have a steady income, a good job, you can afford to eat nutritious food, get regular health screenings. If you have a car, it's easy to go to the doctor, and get some medicine from the pharmacy.

However, for someone who works in a job without paid vacations, or lives in a remote area without proper transportation to a store, the chances of eating nutritious fruits and vegetables and seeing a doctor regularly are very slim, right?

What are examples of these social factors (SDOH)?

Here are some examples of social determinants of health (SDOH):

• Your income level .
• Your level of education .
• Your job and the benefits it provides – for example, health insurance, paid vacation.
• Resources in your neighborhood – things like places to eat nutritiously, public transportation, and childcare centers.
• The safety and security you feel in your neighborhood .
• Access to medical services .
• The quality of the air you breathe and the water you drink .
• Your social connections and associates .

These are just a few examples. These social determinants of health (SDOH) are everywhere you live, work, and hang out. Researchers have divided them into five main categories to make them more clearly understood. According to the U.S. Department of Health and Human Services, these five categories are:

1. Economic stability: Issues related to how much money you earn and whether that income can meet your family's health and other needs.

2. Education access and quality: Issues related to the education you receive and how well it meets your learning needs. This includes learning needs related to the way your brain works.

3. Healthcare access and quality: Issues related to the medical services you receive and the extent to which they meet your physical and mental health needs.

4. Neighborhood and built environment: Issues related to the area where you live, that is, your village or city, and how the resources there help with your health and safety.

5. Social and community context: Issues related to your relationships with your family, friends, work colleagues, and others in the community.

Think about it, all of these factors are interconnected and affect each other. For example, poverty affects every aspect of your life – from what you eat, to where you live, to the amenities you have access to. If you have children, not having access to affordable childcare can be a barrier to getting to work. It can be difficult to get to the store or see a doctor in an area without public transportation or sidewalks.

Simply put, social determinants of health (SDOH) don't exist in isolation – even one or two barriers can have a big impact on your life and health.

So, what does all this tell you? How do you know what the social determinants of health (SDOH) are that are affecting your life? Think about the questions below – they are organized around the five main areas mentioned earlier. You should be able to answer “yes” to all of these questions. Make a note of the questions that you can answer “no”. These are topics that you might want to discuss with a friend, counselor, or doctor.

1. Think about economic stability

• Do you have enough money to buy nutritious food?
• Can you afford medical treatment, seeing a doctor, and buying medicine?
• Do you have enough money to maintain your home and pay the rent?
• Do you have money to pay other bills like electricity and water?
• Can you find affordable childcare?
• Do you think your job is stable ?
• Does your workplace provide health insurance ?
• Does your workplace offer paid time off or sick leave ?
• If you are unemployed, can you join programs that help you find a job?
• Do you have the opportunity to receive career counseling?

2. Think about educational access and quality

When thinking about this section, it can be most helpful to think about the resources your child has (both current and future), but you can also think about your own past or current educational experiences.

• Does your child have the opportunity to receive a high-quality school education ?
• Can you imagine that your child will study up to A-level ?
• Are there resources to help with your child's special learning needs – for example, learning disabilities or intellectual disabilities?
• Does your family have the money to send your child to university or vocational training school?
• Does your child have good friendships with other children at school?

3. Think about healthcare access and quality

• Do you have health insurance ?
• Do you have separate insurance for prescription drugs?
• Do you have dental insurance?
• Do you have a family doctor (`primary care provider`) that you go to regularly?
• Can you understand what your doctor is saying ?
• Do you feel comfortable talking to your doctor?
• Can you find and understand health-related information?
• Can you get your medical records?
• Can you get preventive screenings for diseases like sexually transmitted infections (STIs) and cancer?
• Can you get the treatments you need for your illnesses?
• Do you have a way to get to the doctor (e.g., a vehicle, public transportation)?

4. Think about the neighborhood and the built environment

• Can you easily get to a well-stocked grocery store?
• Can you go to a village market or somewhere else to buy fresh fruits and vegetables?
• Do you have internet access ?
• Do you feel safe in your home ?
• Do you feel safe in your neighborhood ?
• Are there sidewalks in your area?
• Are there separate bike lanes for cycling?
• Does your tap water contain fluoride?
• Is your rent/mortgage payment affordable ? (Affordable means no more than 30% of your income.)
• Is your home free of toxic substances like lead?
• Is the noise level on your street too low to sleep ?
• Does your building have facilities that help you move around slowly (e.g., ramps or elevators for a wheelchair)?

5. Think about the social and community context

• Do you have family and/or friends who encourage you and help you ?
• Do you belong to a social group, such as a temple, a volunteer group, or a mountaineering group?
• Do you have someone to talk to when you are sad or in trouble ?
• Is there anyone to help you with basic needs while you are recovering from a hospital stay or after surgery?
• Do you have the resources to care for your children or other dependents?
• Do you feel accepted at your workplace ?
• Do you feel welcome in your neighborhood ?
• Do you feel connected to others more often than you do lonely ?

Why are these social determinants of health (SDOH) so important?

These social factors (SDOH) are important because they can increase or decrease your risk of developing various diseases. In this way, they can also affect your life expectancy. These social factors have such power because they affect the way your genes work and the decisions you make every day. Let's look at this in a little more detail.

Social factors (SDOH) and your genes

Your genes can affect your risk of developing a disease. For example, you may inherit a genetic mutation – such as a variation in the BRCA1 or BRCA2 genes – that increases your risk of developing a disease like cancer. Or you may be more likely to develop heart disease because your family has a history of heart disease.

But inherited genetic mutations are only one side of the story. Researchers in the field of ``Epigenetics'' are still discovering how the environment you live in affects the way your genes work. We're seeing that everything from the way you were raised as a child to the quality of the air you breathe can turn some genes ``on'' and turn others ``off''.

These ``epigenetic`` changes are not the same as ``genetic mutations`` – your ``DNA`` sequence is the same. But your genes don't work properly. It's like there's a light bulb in a lamp but no one is there to turn it on.

Genes that are turned on or off when they should be can cause all sorts of harmful changes in your body. Tumors are one example. This means that social determinants of health (SDOH), such as social connections and environmental toxins, can affect your genes – even the parts of you that we thought would never change.

Social determinants (SDOH) and your choices

In addition to your genes, the choices you make also affect your risk of developing disease. You can't change the risk factors you inherit. But knowing that you're at risk can help you make choices, such as getting cancer screenings, following a Mediterranean diet, or getting your blood pressure checked regularly. Doing these things can help you reduce your risk of developing certain diseases or increase your chances of getting treatment sooner and getting better.

But is the choice really in your hands? Most of the time, it's not. There may be obstacles in your way, like lack of transportation to see a doctor, lack of income to buy nutritious food. You can't do everything with ``willpower`` alone.

The best thing is for everyone to have access to high-quality resources and opportunities to help them take charge of their health. We're not there yet, but identifying your SDOH is the first step toward that goal. Doctors use a variety of screening tools to find out how these SDOHs affect you and what you can do to help.

What is this ``social determinants of health screening tool``?

These are things like `surveys or questionnaires` that you fill out before you see a doctor. For example, you might fill out a `digital form` before you see your family doctor. The form asks you about various aspects of your life – such as your home, relationships, and how you get food and drink. The questions may be similar to the questions earlier in this article. You might talk about your answers when you see your doctor.

The more you can be open about your concerns, the more likely your doctor will be able to help you. They may be able to talk about solutions to your problems or connect you to community resources. There may be something in your life that the form doesn't mention. If so, talk to your doctor about it when you see him. If the doctor can't help you with a specific issue, he or she will refer you to someone who can.

Social determinants of health (SDOH) start affecting you from the moment you are born, and they continue to shape your health as you age. Some factors can change over time. For example, you may have had a steady income for a while and then suddenly lose your job. Or, you may move from an area with good bus routes and sidewalks to an unsafe area where you can’t get around without a car – and you may not even be able to afford one. The factors that helped your health in the past can suddenly start to hurt it.

But things can also go the other way. You could go years without health insurance or paid vacation, and then find a job that offers both – and you could finally move into a house on a quiet street where you can sleep well. Life is a changing place, and the factors that affect your health are not static.

That means the obstacles you face now don't have to be there forever. If you don't have the resources to help with your health, talk to a doctor or connect with a community group – like a church or a nonprofit organization – who can offer advice and support, and refer you to others who can help.

Take-Home Message

So, from what we've talked about, you probably understand that our health is much more than just taking medicine to cure an illness.

• Your environment matters: Many things, such as the way you live, your income, education, relationships with your neighbors, and the amenities you have, directly affect your health.
• Not everything is in your hands: Sometimes, no matter how much we want to follow good health habits, it can be difficult to do so due to external factors beyond our control.
• Don't be afraid to ask for help: If you have these kinds of questions, talk to a doctor, a family member, or a friend. There are places where you can get help.
• You can make a difference: Your situation doesn't have to stay the same forever. Even small changes can have big results.

Don't forget, your health is your most valuable asset. Try to protect it in every way possible. Becoming aware of these social determinants of health (SDOH) is an important step in that journey!

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