Is medicine the only thing that affects your health? (Social Determinants of Health)

Do you think that your health, that is, your illness, is only affected by viruses, bacteria, food, and medicine? In fact, there are many things that go far beyond that, things that we don't even think about in our daily lives, that directly affect our health. Today, we are going to talk about things like that, things that determine your health but are not part of medical science.

What are the social determinants of health? (Social Determinants of Health - SDOH)

Simply put, Social Determinants of Health (SDOH) are the personal, social, and environmental factors that influence your health and well-being. These are things like your income, where you live, and the amenities available in that area. These are things that are in your life that you don't feel like talking to your doctor about, things that don't seem relevant to medical science.

Imagine, you have a stable job with a good salary, a nice house, and a good hospital nearby to go to if you get sick. Such a person is more likely to have a good nutritious meal, take medicine on time, and, if necessary, have a car to go and see a doctor.

Now think about someone else. That person doesn't have a permanent job, and lives off a daily wage. A bus from home to town and the hospital comes every two hours. They can't even buy vegetables or fruits at the village shop. How difficult is it for someone like this to eat nutritious meals and see a doctor on time when they get sick?

Research has shown that these social determinants of health (SDOH) are not just related to your health, they can actually determine your health . That is, they can determine your risk of developing certain diseases, the type of medical care you can receive, and how well or ill you feel on a day-to-day basis.

These social causes can be divided into 5 main categories:

To better understand these issues, let's break them down into five main categories. This division is done by the US Department of Health and Human Services. But these issues are equally relevant to us in Sri Lanka.

The important thing is that these five areas are interconnected. A problem in one affects all the others. For example, poverty (economic stability) can prevent you from buying good food, living in a good neighborhood, and sending your children to a good school. Similarly, if there is no bus service in your area (environment), it can be difficult for you to get to work or see a doctor (health care). Even one obstacle can affect your entire life and health.

Do these things affect your life? Let's think about it for a moment.

Now you may be wondering, "How does this affect me?" Ask yourself these questions. If the answer to these questions is "yes," that's great. But think about the questions where the answer is "no." It might be a good idea to talk about these issues with someone you trust, or with your doctor.

1. Economic stability

• Do you have enough money to buy nutritious food (vegetables, fruits, meat, fish)?
• Do you have money to go see a doctor and buy medicine for an illness?
• Are you able to pay your rent, electricity bill, and water bill on time?
• Do you feel your job is secure? Aren't you afraid that you might lose it tomorrow?
• Do you get paid leave or sick leave?

2. Education

(Answer these questions thinking about your children. Or think about your past.)

• Does your child have the opportunity to receive a good quality school education?
• If the child has a learning disability, are there resources at school or elsewhere to help?
• Do you have the financial means to provide your child with higher education (university or vocational training)?

3. Healthcare

• Do you have a doctor you trust who you always see when you're sick?
• Can you clearly understand what the doctor is saying?
• Do you feel free to ask your doctor questions without fear?
• Do you have facilities for preventive screenings for sexually transmitted diseases (STIs) or cancer?
• Do you have convenient transportation (bus, three-wheeler, your own vehicle) to see a doctor?

4. Neighborhood and built environment

• Is there a shop or a weekly market nearby where you can buy good vegetables and fruits?
• Do you feel safe at home and in your village or city?
• Are you sure the water coming into your home is clean?
• Are there good walking paths and sidewalks in your area?
• Is the street noise so loud that you can't sleep well at night?
• Are you sure your home is free of toxic substances like lead? (Older paints may contain lead).

5. Social and community context

• Do you have a good friend or family member to share your feelings and talk to when you have a problem?
• Do you have friends or relatives who help you and encourage you?
• When you're sick, is there someone to help you cook, bring you medicine, etc.?
• Do you feel accepted and well-liked at your workplace and among your neighbors?
• Do you often feel connected to others rather than lonely?

Why are these social issues so important?

These factors (SDOH) are important because they can increase or decrease your risk of developing various diseases. They can even affect your lifespan. This happens in two main ways: by influencing the way our genes work and by influencing the decisions we make every day.

1. SDOH and your genes

The genes we inherit from our parents affect our risk of developing diseases. For example, if a person inherits a genetic mutation such as ``BRCA1`` or ``BRCA2``, which is linked to breast cancer, that person is at higher risk of developing cancer.

But the story doesn't end there. A new field of science called epigenetics has discovered that the environment we live in, our lifestyle, changes the way our genes function. Simply put, things like how you were raised as a child, the quality of the air you breathe, and so on can turn some genes 'on' and others 'off'.

2. SDOH and your decisions

In addition to genes, the choices we make also affect our health. For example, if you know that your family has a history of heart disease, you can reduce your intake of fatty foods, exercise, and check your blood pressure regularly. These choices can help you prevent the disease from developing or seek treatment early.

But can you really make that decision on your own? Most of the time, you can't. You may have obstacles in implementing those decisions. Things like not having a vehicle to see the doctor, not having money to buy nutritious food. You can't do these things with just your own strength.

The importance of telling the doctor about this

When you go to see a doctor, sometimes they ask you to fill out a form, right? It might ask about your household details, your diet, your mental health, your job. They don't ask these things for nothing. They ask to understand what social and environmental challenges you face, so they can help you better.

The more openly you talk to your doctor about these things, the more likely he or she will be able to help you. Maybe he or she will be able to provide you with a solution to your problem or point you to other community resources that can help.

For example, if you are experiencing stress, it could be due to a problem at work. Once the doctor knows this, in addition to prescribing medication, he or she may refer you for counseling.

Remember, these social factors have been affecting your life since the day you were born. But they are not always the same. The economic hardship you have today may be gone tomorrow. The environment you live in today may be different tomorrow. Therefore, the obstacles you face now are not permanent.