Almost immediately after the end of World War II, the Economic and Social Council of the United Nations tasked experts to prepare a governing constitutional document for the organization that would become known as The World Health Organization. It was approved on July 22 by the International Health Conference in New York City in 1946. The document was short by today’s standards at just less than one page, but within that short declaration was a definition of health that was significantly more encompassing than the simplistic idea of health equated to the well-being of the physical body.
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” -World Health Organization Constitution.
Scottish Physician Thomas McKeown studied death records from the mid-1800s to 1960 for cases in England and Wales. His work showed that medical advances such as antibiotics were not solely responsible for the regional drop in mortality rates by showing the rates began to decline before introducing these medical advances to the region but after improved living conditions such as clean water, sanitation, and enhanced nutrition. Scholars differ on the reasons that social well-being (and, to a lesser extent, mental well-being) have taken a backseat to the physical for many decades. Still, over the last 30 years, the social aspects of healthcare have begun to receive significantly more focus as research has validated the idea that social well-being impacts physical and mental health.
Today, the Center for Disease Control defines SDOH as: “Conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes.” The CDC has divided SDOH into five general categories. Let’s take a look at each one.
In June 2022, 61% of Americans reported living paycheck to paycheck. 10% of Americans live in poverty conditions. Economic ability or the ability to buy food, shelter, and healthcare is a tentpole societal determinant of health. Steady income or the ability to hold a job is key to economic ability. People with disabilities or conditions like arthritis may be too limited in their ability to work to remain stable. In addition, many Americans who have steady work still don’t earn enough to meet all their basic economic needs. Ways that communities attempt to increase financial stability include:
- Reducing household food insecurity and childhood hunger.
- Reducing the proportion of families that spend more than 30 percent of their income on housing.
- Increasing employment in working-age people.
Education Access and Quality
Studies continue to show that, by and large, people with higher levels of education are more likely to be healthier and live longer. Education access and quality focus on adolescent education and people with disabilities to ensure they progress toward their learning and graduation goals. Students may attend poorly performing schools or leave early because they need to work to help themselves or their families earn money. Exiting formal education makes them less likely to graduate and, in turn, less likely to get jobs that pay enough to have economic stability.
Healthcare Access and Quality
In 2020, 8.6% of all Americans did not have healthcare coverage at any point during the year. 66.5% of Americans had some form of private insurance for at least part of the year, and 34.8% were entitled to public coverage for at least a portion of 2020. Differing insurance solutions mean that many Americans may cover catastrophic coverage but cannot pay for or receive coverage for recommended health services such as cancer screenings and other preventative care and treatments for chronic conditions.
Neighborhood and Built Environment
The area surrounding where you live can have an outsized impact on your health. Rates of violence, polluted air and/or water, and other health and safety risks can impact health daily and, more importantly, may be unavoidable. Whether your residence or neighborhood has access to broadband internet may be an excellent example of the built environment surrounding you. Broadband can enable you to seek telehealth solutions for your preventative care and allow your job search to ensure you stay economically stable.
Social and Community Context
Sociologists have worked to establish a link between social relationships and health outcomes. They’ve found that increased social relationships have both a positive short-term and long-term effect on health and vice versa. Evidence also shows that these effects can emerge in childhood and continue to snowball through life to provide a benefit or hindrance in health. For example, positive relationships at home, work, and within the community can give people the soft skills needed to succeed in the workforce and make life decisions. Access to trusted neighbors, friends, and family members can also help people feel welcome and safe.
How First Response and Telemedicine can Improve SDoH
First responders can uniquely observe the impacts of social determinants of health as they are often at the frontline of providing care and treatment to those within their communities. These interactions create opportunities for first responders to help improve and impact social determinants of health. For example, some EMS agencies may employ a community paramedicine program to help with economic factors or offer drop-in visits to the elderly to support social networks. In addition, some police agencies have alternative programs for unsheltered people to help close the gap between the housing and economic social determinants of health.
One new way of helping to address social determinants of health from a first responder perspective is through 9-1-1-initiated telemedicine. 9-1-1-initiated telemedicine allows dispatchers to route low acuity callers to telemedicine services, including access to physicians, mental health providers, care coordinators, prescription refill assistance, and more. By offering this service, first responders can give those patients needing societal help improved social determinants of health and the overall health of the population they serve. If you’d like to learn more about how your agency can begin improving SDoH through 9-1-1-initiated telemedicine, click here.