Using Social Determinants to Identify Dangers to Health

Over the years I have seen many people question the quantifiable effects of social determinants of health. I used to be one of them. I remember a colleague evangelizing the importance of understanding and considering factors such as income, geographical location and cultural norms in understanding health outcomes. I thought it was “nice to know” but not something we could actually fix. After all, where do you start? How does a health professional begin to understand and account for all the factors that could be impacting a person’s health?

Public health professionals play a significant role in this area. They have the ability to break society into smaller, more manageable bites and delve deeper into what is happening. A great example of this was documented in the a study published in the August 2012 Pediatrics about the increased rate of children admitted to hospitals for child abuse and its link to the housing mortgage crisis.

According to the New York Times report of the study, the rate of hospitalization for children suffering from physical abuse increased an average of 0.79 percent a year from 2000 to 2009. The researchers then linked the data to unemployment rates, mortgage delinquency and foreclosure statistics and found a correlation. For every 1 percent increase in the 90-day mortgage delinquency rate in a metropolitan area, there was a 3.09 percent increase in hospital admission rates for children and a 4.8 percent increase in high-risk brain injuries among children.

Clearly, the economic crisis has increased stress levels across the board. Research by the American Psychological Association (APA) shows work, money and the economy are the most frequently cited sources of stress, the same issues that have topped the list for the past five years.  And while we know that stress has a strong influence on our own health, we may not realize how it is impacting our children. This new research paints a picture. We get stressed. We lose our patience, and we inadvertently take it out on innocent victims in our lives.

As parents, we have all been guilty to some degree of letting stress impact our home lives. What parent has not scolded a child too quickly for doing something wrong simply because we had other things on our mind? If you are worried about how you are going to pay the mortgage next month, you may have less patience for a child who is jumping on the furniture pretending to fly. After all, the noise may be contributing to your headache, and you may worry that he or she may break something you can’t afford to replace.

There are no clear answers on how to fix the problem. But acute awareness is a good first step. Social determinants are the economic and social conditions that influence differences in health. It is most often associated with inequities in health, but – as in this case – it also helps shed a light on potential dangers to a population. Identifying and acknowledging issues like this will help us better address the health of the nation.


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