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The Sum of the Parts: Social Determinants of Health

Nov 8, 2019 | Economic Justice

Your health and well-being are not merely outcomes of what happens in the doctor’s office – they are impacted by the world around you. The place you work, the neighborhood you live in, your education, the relationships you have, your access to health care and healthy food, and your entire physical environment are known as  “social determinants of health,” and they directly shape and influence both your health and conditions of daily life. 1  

Social determinants of health aren’t limited to your immediate physical environment; they also include the socioeconomic context  in which you live. This includes economic policies, social norms and policies, political systems, and development agendas. 2 Research suggests that up to 80 or 90 percent of our health status is determined by social determinants,  and social determinants such as low education levels, racial segregation, low social support, and poverty can increase death rates among disadvantaged populations. 3 Increasing awareness around the different conditions Americans live, work, and play in helps to paint the picture of why some communities are healthier than others, and why some populations struggle more than others to be the healthiest they can be. 4

In comparison to other industrialized countries, the U.S. spends more on health care, but less on social services. 5 Rather than focusing on prevention and elevating the health of individuals, the health care system has focused largely on treating patients after they succumb to the consequences of health disparities and their social determinants. Chair of Population Health at the University of Texas Dell Medical School Dr. Bill Tierney says, “In primary care there is limited time to deal with promotion and disease prevention. There is no ICD-9 code for ‘preventive care’. The main focus is on treating diseases – things that make people sick – rather than things they do to stay well.” 6

A primary social determinant of health is access to healthy food. Currently, nearly 4.3 million Texans experience food insecurity. The Rio Grande Valley is a prime example of a region in Texas experiencing food insecurity. Residents living in rural areas, or colonias, and poor neighborhoods have limited access to healthy food. Grocery stores in these areas often are far from residential areas, making transportation another barrier to healthy living, stores located conveniently for poor neighborhoods often sell less nutritious food. 7 Individuals living in these food deserts frequently resort to purchasing low-quality or processed food because many times the alternative would be not to eat. The effects of food insecurity can demonstrate how one social determinant alone can significantly alter health outcomes. For women, food insecurity is often associated with obesity, anxiety and depressive symptoms and negative pregnancy outcomes.8 For children, it is associated with anemia, asthma, depression and anxiety, and cognitive and behavioral problems. 9

Increased study of social determinants of health, as drivers of Americans’ health status and health care costs, has led to a wide range of efforts being implemented throughout the country. The Centers for Disease Control has focused on various social determinants with projects such as the Built Environment and Health Initiative: Designing and Building Places. 10 The Center for Medicare and Medicaid Innovation’s model “Accountable Health Communities”; Department of Housing and Urban Development’s Healthy Home Program; and Department of Health and Human Services Office of Community Services Low Income Home Energy Assistance Program also are examples of programs designed to address social determinants. Here in Texas, The University of Texas, in conjunction with the Episcopal Health Foundation, has rolled out the Factor Health program, the Episcopal Health Foundation has also helped launch the Texas Community Centered Health Homes program. The Texas A&M Rural and Community Health Institute has also begun working with hospitals and their communities to “determine feasible health care options that will be supported by the community” and ultimately meet its needs. 11 

 



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  1. “Social Determinants of Health .” World Health Organization, n.d. https://www.who.int/social_determinants/en/
  2. “Social Determinants of Health .” World Health Organization, n.d.
  3. Galea, S., M. Tracy, K.J. Hoggatt, et al., “Estimated Deaths Attributable to Social factors in the United States,” American Journal of Public Health 101(8):1456-1465, 2011
  4. “Social Determinants of Health.” Office of Disease Prevention and Health Promotion. Healthy People 2020, n.d. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health.
  5. Thomas-Henkel, Caitlin, and Meryl Schulman. “Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations.” Screening for Social Determinants of Health in Populations with Complex Needs: Implementation Considerations. Center for Health Care Strategies, October 2017. https://www.chcs.org/media/SDOH-Complex-Care-Screening-Brief-102617.pdf.
  6. Wilson, Kimberly J. “Building a Culture of Health in Texas.” Building a Culture of Health in Texas. It’s Time Texas, n.d. https://itstimetexas.org/wp-content/uploads/2016/07/white_paper_final.pdf.
  7. Galvin, Gaby. “Feast or Famine in South Texas.” U.S. News & World Report, May 16, 2018. https://www.usnews.com/news/healthiest-communities/articles/2018-05-16/feast-or-famine-food-deserts-a-problem-in-texas-rio-grande-valley.
  8. “Health of Women and Children.” United Health Foundation, n.d. https://www.americashealthrankings.org/explore/health-of-women-and-children/measure/food_insecurity_household/state/TX.
  9. “Health of Women and Children.” United Health Foundation, n.d. 
  10. “Social Determinants of Health: Know What Affects Health.” Centers for Disease Control and Prevention, n.d. https://www.cdc.gov/socialdeterminants/cdcprograms/index.htm.
  11. Bolin, Jane, Bree Watzak, and Nancy Dickey. “Rural Hospital Closings Reach Crisis Stage, Leaving Millions Without Nearby Health Care.” Texas A&M Today, September 30, 2019. https://today.tamu.edu/2019/09/30/rural-hospital-closings/.