The Social Determinants of Health

Pre-read summary:
-What are social determinants of health, and why should I care, you fascist?
-Another mention of Dr. Mukherjee.
-Not that kind of social network.
-Stressed out mommies make stressed out babies.
-This article by Dr. Bezruchka.
-More reasons for libertarians to think I'm a commie.
-Social context.

Now THIS is a big topic.

So earlier I mentioned this concept of the social determinants of health and made the contention that the social context of the world we live in plays a larger role in our health than other individual factors, such as availability and quality of health care or the number of cardiologists in your area. But what exactly does this mean? What in the hell are "social determinants of health?"

To help answer that question, let's look at Siddartha Mukherjee's (MD, by the way, so pay attention) question in his book:

"Epidemiologists typically measure the risk factors for chronic, noninfectious illnesses by studying the behavior of individuals. But recently, they have asked a very different question: what if the real locus of risk lies not in the behaviors of individual actors, but in social networks?"

This isn't about Facebook. What Dr. Mukherjee was referring to here was the idea that behaviors (positive and negative) are reinforced through social norms. That is, the group you hang out with has a large influence on your behavior. The example he goes onto refer to in the book is social networks of smokers and the proliferation of lung cancer within these circles.

Social groups play a large role in rates and incidences of noninfectious diseases. But it goes beyond the groups an individual associates with. Policy measures having to do with social inequality also play a big role. For instance, there is a growing body of evidence that suggests that environmental factors during first 1000 days of life can have life-long effects on a child. Psychosocial stress certainly has a negative impact in utero. Political measures that disallow or make difficult the ability for parents to care for their newborns just may have an irreversible impact on that child's life.

 Let's see what Dr. Bezruchka has to say about this:

"The United States does not provide paid maternity leave nor paid prenatal leave, which may be important factors in affecting health outcomes."

Now, he didn't just pull that statement out of the ether. This quote comes from his article "The Hurrider I Go, the Behinder I Get." That one statement has seven citations to support it. This particular article describes (in great detail) how universal medical care and personal behavior are not limited in their ability to determine health outcomes when compared to social inequality and lack of health outcome orientation in political infrastructure.

Another argument addressed in Dr. Bezruchka's article is one I've only rarely heard, but bears scrutiny. Doesn't the fact that people of so many different ethnic and racial backgrounds skew the health outcome numbers for this country? Are unhealthy immigrants bringing our numbers down? It doesn't look like it. Can you believe that first generation Hispanic immigrants have lower infant mortality and longer life expectancy numbers than non-Hispanic whites in the U.S.? It's true. (Interestingly, studies of second-generation immigrants demonstrate a substantial lowering in those numbers).

So. Health outcomes are bigger than what medicine you take, which doctor you see, and how many gallons of soda you imbibe on a daily basis. To be sure, each of these things is important. But in order to the full picture of how important these things are, we need to contextualize them within the bigger framework of the social setting in which we all live. This contextualizing is what makes clear the importance of the social determinants of our health.