Spotlight on Social Determinants of Health: Health and Healthcare

Introduction

We’ve written about Social Determinants of Health (SDoH) and their impact on health before. In this series, we delve more deeply into the five main issues and their contributing factors.

Economic Stability > Education > Health and Healthcare > Neighborhood and Built Environment > Social and Community Context

As we’ll see throughout this series, social determinants are not standalone problems, but a web of interconnected issues. Substandard education can lead to unemployment, which can lead to poverty, which can lead to housing instability, food insecurity and a lack of access to healthcare.

Access to Healthcare

“Access to healthcare is the timely use of personal health services to achieve the best possible health outcomes.”

- The National Academies of Sciences, Engineering, and Medicine

According to the CDC, almost one in 10 U.S. residents, 31.1 million people, did not have health insurance in the first half of 2021. That includes 4.4% of children, 31.4% of Hispanic adults and 14.7% of Black adults, highlighting the stark disparities in access to health coverage.

Not having health insurance is a significant barrier to receiving care, but it’s not the only one. Lack of access to transportation is another. Financial insecurity can also cause even those with insurance to forgo services if copays and deductibles are too high.

Access to Primary Care

“Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”

- The National Academies of Sciences, Engineering, and Medicine

Primary care providers (PCPs) are the critical hub of a person’s wellness team. We see the snowball effect here, too—those without coverage are much less likely to have a PCP, and those without a PCP are less likely to get annual check-ups or preventative care for illnesses like cancer, heart disease and diabetes. Uninsured children often live with untreated conditions such as asthma, and don’t receive adequate dental care or vaccinations.

Other barriers to primary care access include lack of transportation and/or living far from providers. These can also present significant obstacles to care and are linked to late-stage discovery of serious conditions such as cancer. Language barriers are often a problem, patients may have a disability that makes it difficult to travel and, in some areas, a shortage of PCPs can lead to long wait times for an appointment.

Health Literacy

“Health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

- The National Academies of Sciences, Engineering, and Medicine

Low general literacy can contribute to low health literacy—it’s easy to see how someone who has difficulty reading would have trouble understanding a pamphlet explaining why colon cancer screening is important—but it’s possible for literate people to struggle with health literacy too. Prescription bottle labels are generally poorly designed, which can lead to confusion and low medication adherence.

It's important that providers and systems work toward identifying those with low health literacy, but it can be difficult, particularly if the patient has good verbal communication that could mask poor written comprehension. As a result, providers should act as if all patients and caregivers have low literacy and communicate in ways that anyone could understand.

It’s another interconnected issue that disproportionately impacts minorities, low-income communities and the elderly. One study found that 74% of Spanish-speaking patients have inadequate health literacy versus 7% of English-speakers.

Addressing social determinants of health is a complex process that requires coordination among a wide range of systems and stakeholders. As we work to build an environment conducive to true whole person care, there are steps we can take in the meantime to better understand the barriers individuals may be facing. Empathy and awareness are small steps that can go a long way toward overcoming some of these challenges and, certainly, informing the development of solutions that address social determinants in a meaningful way. 

Economic Stability > Education > Health and Healthcare > 
Neighborhood and Built Environment > Social and Community Context 

Check back soon for our next article focused on Neighborhood and Built Environment. If you’d like to find out when a new article is posted, please use the social media links at the bottom of any page on our site.