My first job in Colorado, when I moved here twelve years ago, was in affordable housing. When we talked about the impact of our work, we talked about a lot of really important things—dignity, self-sufficiency, economic mobility—but we never talked about the impact of housing on health. We worked with other affordable housing organizations to advocate for more and better affordable housing, but we didn’t engage much on non-housing issues. Certainly not legislatively, at least. And it seemed like most other issue areas operated like that, too.
However, one problem with treating housing, food access, education, and other social determinants of health as separate issues, is that it’s hard to drive meaningful change. Changing policies, systems, and narratives requires a large coalition of supporters, which is tough to rally from within our siloed sectors. Another problem with treating these issues as separate is that it defies several decades’ worth of evidence that conclusively shows how interconnected they all are. For example, one study asked Latino and African American families living in poverty to name the factors contributing to poor health in their community, and they identified racism, lack of economic opportunity, and neighborhood conditions—as well as poor access to health care. In this way, and many others, communities have been saying for generations that health is complex and health care alone can’t fix things. Yet, until fairly recently, more and better health care has been seen by policymakers, the health care system, and other decision makers as the ultimate solution to poor health. That’s a major reason why the US spends so much more on health care than on social determinants of health.
The good news is that our approach to improving population health has finally begun to change. Health care leaders are advocating for driver’s licenses for immigrants, insurance companies are investing in affordable housing, and health systems are partnering with food access and ride share programs. And, they’re doing these things largely because communities are demanding change. These are important developments. But they’re not enough.
Just as floating downstream in an actual river is easier than working one’s way upstream through the current, it’s easier to fulfill a person’s social needs than to address the underlying cause of a community’s barrier to good health. It’s easier (not easy, but easier) to provide housing, food, and transportation to those who need it than it is to support the systems, policies, and infrastructure that let our neighbors live their healthiest lives on their own terms. Fulfilling those needs at an individual level may be a critical short-term solution, but in the long-term it doesn’t solve the issues communities are facing.
I hope as our work to address the social determinants of health evolves, we keep our eyes pointed upstream and work toward community- and systems-level solutions. I hope we’ll also continue to look for opportunities to step outside the traditional lane lines of various social issues and form larger, more powerful coalitions for change. And most of all, I hope we’ll do a better job of making space for communities to lead these change efforts, because they’re miles ahead of us in their understanding of both the problems and the solutions.