Over the past four months, my house has been under major construction. During this time, we’ve faced some challenges as a family—living amidst the construction dust and bouncing from vacation rentals to relatives’ and friends’ houses. It is a huge privilege to be able to make the choice to remodel our home. But, with two small tykes running around, the experience has provided us with a small window into the impact unstable housing can have on one’s life. I’ve felt anxious, isolated, and stressed attempting to maintain some normalcy for my young kids and trying not to burden others while living in their homes. Despite my best efforts, maintaining a modicum of my normal routine, including exercise and healthy eating, has been nearly impossible.
I’ve been studying the science and theory of the social determinants of health (SDOH)—or the structural determinants and conditions in which people are born, grow, live, work, and age—for many years. But, all the studies in the world can’t compare to experiencing something firsthand. My small, personal experience demonstrated just how easily, and quickly, your health can be disrupted if the conditions surrounding you aren’t stable.
The data is clear, SDOH are the greatest predictors of a person’s health—more than genetics, individual behavior choices, and access to health care. SDOH are also significant drivers of preventable health disparities, including those prevalent throughout Colorado. In general, SDOH fall into one of four domains:
- Environmental: pollution, housing, crime, access to transportation and healthy food, and other aspects of the spaces we inhabit
- Economic: income, employment, personal education, and opportunities for upward mobility
- Interpersonal: discrimination, violence, social bonds, and other interactions between individuals
- Institutional: the education system, criminal justice system, government, and the structures of major institutions that advantage some and disadvantage others
Historically, public health and other health care interventions have largely focused on disease control and prevention, rather than SDOH. As the impacts of SDOH have been further understood, health care interventions, including many in Colorado, have begun to address some aspects of the physical environment and, at times, economic opportunity. Very few interventions exist, however, in the interpersonal and institutional domains.
Over the past two years, Center for Health Progress has been interested in understanding why that is. As we began to learn the root causes behind interpersonal, institutional, and societal inequities, it became clear that our health care system, and society as a whole, struggles to grasp where and how to intervene at these levels. We believe this is in large part due to fear, discomfort, and the politicized nature of issues like institutional racism, classism, and other systemic oppression. We can develop health care interventions that tackle unstable housing, food insecurity, and transportation because we’re comfortable talking about these issues and they are easy to grasp, but we haven’t asked ourselves why certain populations and individuals consistently, disproportionately face these challenges.
Colorado leaders are beginning to have brave new conversations about inequity. And nationally, health care leaders are beginning to wrestle with these intractable issues in the public sphere. As an organization, we have been an active participant in these conversations and I believe it’s beginning to turn toward action. If we are to truly achieve health equity and eliminate preventable health disparities, we have an obligation to address institutional and interpersonal root causes head-on. In doing so, we can find commonsense solutions that transform the health and lives of our neighbors and make Colorado stronger.