Do you know about these social factors that affect your health? (Social Determinants of Health - SDOH)

We all go to see a doctor when we are sick. Then we talk about our illness and medicine. But have you ever thought about how much your financial problems, the environment you live in, and the education you receive affect your health? Those are the non-medical things that we are going to talk about today, but they have a huge impact on our health.

What are these social determinants of health (SDOH)?

Simply put, social determinants of health are the personal, social, and environmental factors that influence your health and well-being. These include things like your income, where you live, and the amenities in your neighborhood. In fact, these may be non-medical aspects of your life. You may not even talk to a doctor about these things because you don't realize how they might be related to illness.

However, 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 affect your chances of developing certain diseases (we call them risk), the medical care you receive, and how well you feel from day to day.

Think about it this way, if you have a stable income, health insurance, it's easier for you to buy good nutritious food, get regular health checkups. If you have a car, how easy is it to go to the doctor, and get medicine from the pharmacy?

But, for someone who works without paid leave, or lives in a remote area with no good shops or even a bus, how difficult is it to buy some vegetables and fruits to eat and see a doctor on time?

What are examples of social determinants of health (SDOH)?

Here are some examples:

• Your income.
• Your level of education.
• The job you do and the benefits it provides - like health insurance and paid vacation.
• The amenities around you - places to find nutritious food, public transportation, and childcare.
• The security you feel in your surroundings.
• How far are medical facilities?
• The condition of the air you breathe and the water you drink.
• Your relationships with family and friends.

These are just a few examples. These SDOHs are everywhere you live, work, and hang out. Researchers have divided them into five main categories to make them easier to understand. 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 is sufficient to meet your family's health and other needs.

2. Education access and quality: The education you receive and how well it matches your learning needs (including those related to the way your brain works).

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

4. Neighborhood and built environment: Things related to the area where you live - things like facilities that help with your health and safety.

5. Social and community context: Your relationships with family, friends, work colleagues, and others in the community.

It's important to remember that 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 young children, the lack of affordable childcare can affect your ability to get to work. How difficult is it to get to the grocery store or to see a doctor in an area without public transportation or sidewalks?

In other words, these social factors that affect health do not exist in isolation - even if one or two are a hindrance, they can affect your life and health like links in a chain.

How do these factors affect you? Let's think about it for a moment.

So, what does all this tell you? How do you know which SDOHs are affecting your life? Think about the questions below. These are organized according to the SDOH categories mentioned earlier. You should be able to answer "yes" to all of these questions. Make a note of the questions to which you answer "no." These are topics you might want to discuss with a friend, counselor, or doctor.

1. Let's think a little about economic stability?

• Do you have enough money to buy nutritious food and drinks?
• Can you afford to pay for medical services, such as seeing a doctor and getting medicine?
• Do you have money to pay rent or build a house?
• Do you have enough money to pay other bills, like electricity and water?
• Can you find low-cost ways to care for your children?
• Do you think your job is stable?
• Do you have health insurance from your workplace?
• Does your workplace offer paid leave?
• If you are unemployed, are there any programs that can help you find a job?
• Do you have the opportunity to receive career guidance?

2. What do you think about educational access and quality?

In this case, it's most helpful to think about the opportunities your child has (both current and future), but you can also think about your own past or current educational experiences.

• Can your child get a good quality school education?
• Can you imagine your child finishing school?
• Are there facilities to help with your child's special needs (e.g. 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 relationships with friends at school?

3. How is healthcare access and quality?

• Do you have health insurance?
• Is there separate insurance for medication?
• Is there insurance for dental treatment?
• Do you have a family doctor you go to regularly?
• Do you understand what your doctor is explaining?
• Do you feel comfortable talking about your feelings with your doctor?
• Can you find and understand health-related information?
• Can you get your medical records?
• Do you have access to preventive screenings for sexually transmitted infections (STIs) and cancer?
• Are you able to get the treatment you need for your illnesses?
• Do you have a way to see a doctor?

4. What do you think about your neighborhood and the built environment?

• Can you easily get to a well-stocked grocery store?
• Is it easy for you to go to a market or somewhere else where you can buy fresh fruits and vegetables?
• Do you have internet access?
• Do you feel safe in your home?
• Do you feel safe in your surroundings?
• Are there sidewalks in your area?
• Are there separate roads for cycling?
• Does your tap water contain fluoride? (It's good for your teeth)
• Is the house you live in affordable? (That means it doesn't cost more than 30% of your income)
• Is your home free of toxic substances like lead?
• Is your street quiet enough for you to sleep?
• If you have difficulty walking, does the building you are in have facilities for that (e.g. ramps or elevators)?

5. How are social and community relations?

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

Why are social determinants of health (SDOH) important?

These SDOHs are very important because they can increase or decrease your risk of developing various diseases. This can also affect your lifespan. SDOHs get this power because they influence the way your genes work and the decisions you make every day. Let's look at this in a little more depth.

SDOH and your genes

Your genes affect your risk of disease. For example, you may inherit a gene mutation (such as a variation in the BRCA1 or BRCA2 genes) that increases your risk of a condition 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 a field called ``epigenetics`` are now discovering how your environment affects the way your genes work. We're seeing how everything from how you were raised as a child to the quality of the air you breathe can turn certain genes ``on`` or ``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 are light bulbs in the lamps but no one is there to turn them on.

Genes that are turned on or off when they should be can cause all kinds of harmful changes in your body. Tumor growth is one example. This means that social determinants of health (SDOH), such as social relationships and environmental toxins, can influence your genes—even parts of you that you thought would never change.

SDOH and your decisions

In addition to your genes, the choices you make also affect your risk of disease. You can't change the risk factors you inherit. But knowing that you're at risk can help you make some decisions - like getting cancer screenings, adopting a healthy diet (like the Mediterranean Diet), or checking your blood pressure regularly. Doing these things can help you reduce your risk of some diseases, or increase your chances of getting treatment early and recovering.

But can you really make that decision on your own? Most of the time, you can't. There may be obstacles in your way, like not having transportation to see a doctor or not having enough money to buy nutritious food. Sometimes, just having the willpower is not enough.

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 recognizing how social factors that affect health affect you is the first step toward that goal. Doctors use a variety of screening tools to find out how SDOH affects you and what you can do to help.

How does a doctor find out about this SDOH?

SDOH screening tools are 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 about various aspects of your life - such as your housing, relationships, and access to food and water. The questions may be similar to the questions earlier in this article. When you see your doctor, he or she may discuss your answers with you.

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

Can these situations change?

Social factors that affect health start to affect 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 a stable 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 area that is unsafe and inaccessible without a car - perhaps even unable to afford one. Factors that used to help your health can suddenly start to harm your health.

But things can also go the other way. You could go years without health insurance or paid vacation and suddenly find a job that offers both - and you could finally move to 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 always as constant as you think, and they can change.

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, a temple, or a nonprofit organization - who can offer advice and support, and introduce you to others who can help.

What is the message we want to take home?

So, the most important thing we need to understand from all of this is that our health is greatly affected by the social, economic, and environmental conditions (SDOH) in which we live, as well as by medications .

• The first step is to become aware of what these SDOHs are and how they affect us.
• If you have questions like these, don't be afraid to talk about them with a doctor or someone you trust.
• Often, there are ways to change these situations and get help. You don't have to suffer alone.
• Good medical facilities and a good quality of life are essential for a healthy life.

So, when you think about your health, think about these social issues as well. It will help you stay healthier and happier!

` Health, social factors, economic stability, education, healthcare, environment, social relations