Written by: Ayelet Portman, Dietetic Intern

What Are Social Determinants of Health?


Determinants of health are a group of personal, social, economic, and environmental factors that affect your health (1). These determinants work together to influence your health including medical conditions, nutrition, physical activity, and risk of chronic diseases. Social determinants of health, which include socioeconomic status, built or physical environment, food environment, housing stability and access to health care, are strongly associated with determining health outcomes, including diabetes (2). 


Socioeconomic Status 


Socioeconomic status includes education, economic and occupation status, affecting overall health. All of these factors work together with other social determinants of health to determine access to food, housing stability, the quality of the neighborhood they live in, which subsequently lead to being able to manage diabetes better or worse or develop diabetes at all (2).  Research shows that those who are in a lower socioeconomic status are more likely to develop type 2 diabetes, have more complications relating to it, and have a faster mortality rate than those with a higher socioeconomic status (2).


Education also seems to be a strong influence in developing diabetes. It is shown that the more educated someone is and the better occupation or higher income they have, the less likely they are to develop type 2 diabetes (2). Research conducted with adults with type 1 diabetes showed that compared to those who do have a college degree, those who do not have a college degree are three times as likely to die from diabetes (2). Having a higher literacy and understanding of healthcare is associated with higher education, and therefore makes it more likely that you will be able to manage your diabetes well (2). 


Research suggests that occupation determines the risk of diabetes and the severity of it as well. A survey among the U.S. population showed that the occupation with the highest prevalence of diabetes was transportation workers and those that had the lowest prevalence of diabetes were physicians (2).  Future research has shown that individuals who worked fewer hours, made more money, and were less stressed due to more social support, had better access to healthcare and management of diabetes and overall lower A1c levels (3). 


Housing Stability


Housing stability, food security, and built or physical environment are all strongly associated with developing diseases and managing them. House instability leads to an inability to meet self-care needs and worsening of chronic or other medical conditions (2). Although it is still unclear if there is a direct correlation between housing insecurity and incidence of diabetes, housing instability is strongly associated with lower socioeconomic status (which does affect the prevalence of diabetes) (2). 


Food Security 


Being food secure means you have access to healthy and balanced meals, fresh fruits and vegetables, and affordable foods that provide nutrients. Without access to healthy food choices, it increases the chances of developing diabetes and makes it more difficult to manage diabetes once you are diagnosed with it (2). Research has shown that individuals who live in food-insecure households are more likely to have poor health outcomes and a higher risk of developing diabetes (4). Across the nation, 37.2 million people are considered food insecure and accounting for $77.5 billion in annual health care costs in the U.S. (4). Food security is associated with a higher risk of chronic conditions and is an important component of health to address since it is currently a prominent issue around the world.


Built Environment 


A built environment is also a major indicator of health risk. A neighborhood that allows for easy access to physical activity, such as paved sidewalks, parks and trails to walk around, and bike lanes for bikers, affect the chances of developing diabetes. Studies have shown that neighborhoods that have access to these resources for pedestrians and bikers that encourage physical activity have a lower incidence of type 2 diabetes and better outcomes of managing it overall (2).   


Take-Home Message


When thinking about what affects your health, you may think it is because of what you eat, or how much you exercise, or what genes you inherit from your family. But health is so much more than that, and social determinants are components of your health that you can’t necessarily control and are important to understand when considering your healthcare and lifestyle.

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