Spotlight on Social Determinants of Health: Neighborhood and Built Environment

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 Healthy Foods 

“Let food be thy medicine, thy medicine shall be thy food.”
 – Hippocrates

Eating an unhealthy diet delivers poor nutrition and increases the risk of developing high blood pressure, diabetes and cancer. A healthy diet includes a mix of fruits and vegetables, whole grains, low-fat dairy and healthy proteins such as seafood, lean meats and poultry, legumes, nuts and seeds, soy products and non-trans-fat oils.

Unfortunately, many minority and low-income households are in areas where access to these foods is difficult or impossible. The USDA defines these areas as “food deserts,” though the Food Empowerment Project believes that term insufficiently addresses issues beyond simple geographic proximity to healthy options. They consider phrases like “food apartheid” or “food oppression” to more accurately speak to underlying social determinants such as racism, cost of living, poverty etc.

And as with most social determinants, race and education level are indeed strong factors. Research has shown that 44% of Black adults have poor diets compared to 31% of whites, an increase of almost 50%. Among children whose parents’ education stopped at high school, 63% have poor diet compared to 43% for those with at least one parent with a college degree.

Crime and Violence

“Poverty is the mother of crime.”
 – Marcus Aurelius

That violence affects health seems self-evident; however for a person’s health to be affected, they need not be the direct victim of a crime. Stress introduced by living in a high-crime neighborhood can also create poor health. And the crime does not necessarily need to be violent or directed at an individual. Even vandalism and damage to the built environment reduces the quality of life in an area and can lead to reduced health. Those who feel their neighborhood is unsafe are less likely to exercise outside, increasing the likelihood of obesity and other chronic diseases.

Young people exposed to violence are at greater risk for poor long-term behavioral and mental health. And “exposure” can be direct or indirect — they may witness violence, or even simply hear about it. All three can impact health and cause depression, anxiety and PTSD.

Children who experience violence are more likely as adults to engage in risky sexual behavior, struggle with substance abuse, be unsafe drivers and inflict or experience domestic violence.

Environmental Conditions

“If we wish to rebuild our cities, we must first rebuild our neighborhoods.”
 – Harvey Milk

When we look at environmental conditions that affect health, we are talking about air pollution, unclean water and extreme heat. In 2012, the World Health Organization determined that 11% of deaths in the U.S. (almost 300,000 people) were due to environmental causes.

Poor air quality increases the risk of cardiovascular disease, lung cancer and asthma. Air pollution can be experienced indoors as well as outdoors. 

Almost a third of Americans get their drinking water from groundwater, yet in one study, 22% of these sources were contaminated. This can be caused by leaky storage tanks, agricultural runoff, waste dumps and septic tanks.

Air temperature is a factor that may seem surprising, but older adults and children are at risk for heat-related disease and death.

And again, we see higher rates of poor environmental conditions in minority and low-income neighborhoods.

Housing Quality

“Housing is absolutely essential to human flourishing. Without stable shelter, it all falls apart.”
—Matthew Desmond

Housing quality is concerned with the physical condition of a person’s home and overlaps with other determinants such as environmental conditions and crime and violence. The presence of lead, asbestos and mold, even in low levels, negatively affects health. Poor home maintenance can lead to situations such as faulty appliances, exposed nails or dangerous stairs. Carbon monoxide in the home can cause cardiovascular disease, neurological disorders and death.

Overcrowding in the home leads to poor mental health, infectious disease transmission and food insecurity.

Health Is More Than Medicine
Changes in public policy have been shown to mitigate many of these determinants. For example, a small fiscal incentive offered to Supplemental Nutrition Assistance Program (SNAP) recipients when they shop at farmer’s markets resulted in increased consumption of wholesome food. 

Much needs to be done to address the great chasm of disparity between various ethnic and socioeconomic cohorts; however, as the success of the SNAP farmers’ market program shows, even small incentives can have a meaningful impact. It all starts with recognizing the many factors outlined in this series for what they are — determinants of health — and banding together to meet the multitude of people’s healthcare needs. We see ample opportunities for healthcare, public health and human services systems to better communicate with one another around the needs of our vulnerable populations, and for technology partners like Gainwell to enable the effort.  

This is part four in a five-part series taking a deeper look at each of the following social determinants of health:

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

Check back soon for our next article focused on Social and Community Context. 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.