Social Determinants of Health

"Social Determinants of Health" Sounds complicated? Sounds like jargon? It's not, really. In fact, an excellent seminar yesterday, sponsored by Blue Cross/Blue Shield, shed light on how education, income, and the features of the places where we live literally add or subtract years from our lives.

For example, people who don't graduate from high school earn less during their lives than people with more education. You might expect that, but statistics show that they also more often suffer from obesity and cancer; they die at earlier ages. A major study in England, featured in a to-be-released PBS series, shows a strong and direct correlation between income (or social status) and health status and life expectancy.

In the past, we have tended to put emphasis on individual choices and behaviors as the factors that affect our health. If we choose to smoke, our health will suffer; if we choose to exercise, we will remain fit and less likely suffer from many chronic diseases. We have also recognized that we inherit some characteristics from our parents; as the New York Times reported today, commonly-available DNA testing will soon enable everyone to "learn what is known so far about how the billions of bits in their biological code shape who they are."

Our DNA, and the lifestyle choices we make, do influence our health. However, they might explain only a fourth or a third of the differences among people. The research summarized yesterday by Dr. Anthony Iton, suggests that individual choice might account for only 15-30% of the explanation for why some people stay healthier, and live longer, than others. It also showed strong differences in disease rates and life expectancy depending upon people's places of residence. Even within the same geographic areas (Alameda County CA was one example; Louisville KY was another.), residents living just a few miles from one another show great differences in health, in a very predictable pattern: neighborhoods with poorer, less educated residents, with worse housing, with higher levels of uncollected waste, live shorter, less healthy lives. And, this pattern does not just influence the lives and well-being of poor people. Residents of middle class neighborhoods can live 3-5 years less than residents of wealthier neighborhoods.

If you think that these issues do not apply in Minnesota, think again - and watch for data we will report in our Twin Cities Compass project. Disparities do exist. They have real effects, as you will see. The Brookings report, "Mind the Gap", sponsored by the Itasca Project identified disparities based on race, income, and place as some of the most significant challenges for the future vitality of our region.

It's immoral, in my opinion, that we should have these disparities. Total equality might not be possible, but we can certainly bring everyone to a minimum level of education, so they can participate in work life and civic life. We can certainly narrow the gaps to a minimum.

Perhaps the moral argument makes sense, but still does not sway you - consider the practical side. Health disparities affect you very directly. Health disparities cost you money right now, and they jeopardize your future well-being, regardless of your social status. People of color constitute the growing populations in our region. They make up the work force of the future, the parents of the future, the leaders of the future. If the up-and-coming part of our community is less healthy now, we all pay in the form of increased insurance costs and taxes; if they have poor health, and die earlier, in the future, we all lose the value of their productivity and the many contributions they can make to our society.

There is little doubt that we must understand the "social determinants of health" and address the disparities in our region, if we want our region to stand out internationally as one of the best places to live.

(Watch for the PBS documentary, Unnatural Causes, next year. Watch also for the TPT series on disparities in the Twin Cities region, and their effects on all of us. Twin Cities Compass and Wilder Research are partnering with the Itasca Project and TPT on education and follow-up activities for that series.)