So much of the cost of health care has already been written. It’s woven into the fabric of our everyday lives. The dominant American narrative is largely a self-sufficient one. Exercise daily, eat healthier, work harder, rest more and live better. These are proven strategies to improve health. However, there are elements of our society even more influential over health outcomes — or at least affect the ability to improve health. In the health care community, we refer to these things as social determinants of health.  

As a term or phrase, social determinants of health is thrown around, but often without deeper explanation as to what it actually means.  In contrast to the fiercely individualized,
self-sufficient narrative I described above, social determinants of health relate to aspects of a person’s life that can’t easily change overnight, in the next year or — in many cases — ever.  

Social determinants of health look beyond disease to understand factors contributing to quality of life and, ultimately, affecting health. They include access to food and housing as well as employment, schools, stable childcare and transportation. Income and ethnicity as well as community, crime and safe places to recreate all influence whether or not a person lives a healthy life. Often, where you live determines how long or well you live and how much your health care costs. Social determinants of health are generally systemic and contribute to broad health inequities and disparities. 

Consider the neighborhood where you live. In Flint, Mich., for example, residents used a water supply contaminated with high levels of lead over a period of five years, exposing upwards of 14,000 children. While that was a famous case, lead toxicity is actually common. One in every 40 children in the United States has elevated levels of lead in his or her blood, which attacks the developing nervous system and contributes to lower IQ, impaired growth and hearing loss. Prolonged lead exposure carries ripple effects into adulthood, increasing risk of high blood pressure, heart disease, kidney disease, reduced fertility and likely cancer. Higher health care expenses are waiting for one in 40 American children 30 years from now due to lead in their environment today.

Food deserts offer another example. A food desert is an area with limited access to affordable and nutritious food — a place without a grocery store in close proximity or a store that carries only shelf-stable processed foods with high caloric content. According to a U.S. Department of Agriculture food access research map, several areas in Mesa County are considered to have low access to nutritious food. Not only do food deserts lack access to fresh fruits and vegetables, but they’re also filled with fast food options. There’s a strong correlation between high percentages of people living in poverty and food deserts. Presented with a limited budget and even more limited options for nourishing food, families can find themselves in a difficult position. Unsurprisingly, research shows the presence of many fast food options in a community is a strong predictor of obesity rates. Obesity leads to many of the most common causes of death in the U.S., among them cancer, diabetes, heart disease and stroke.

It’s important to include social determinants of health in any conversation about improving health outcomes or reducing health care costs. Medical care itself is only estimated to contribute to about
10 percent to 20 percent of health outcomes. Non-medical factors make up the rest. It’s critical to address those aspects of our community and society that erect barriers to healthy lifestyles. Ignoring these issues simply adds to ballooning health care costs in this country.  

Solutions to address social determinants of health come in many forms. Such public services as education as provided by Mesa County School District 51 or stable housing programs administered by the Grand Junction Housing Authority play a critical role. Coalitions and multi-stakeholder partnerships, such as the Community Transformation Initiative serving the Clifton community, prove instrumental in bringing needed resources to address social determinants of health. Private companies, both nonprofit and for-profit, should play a big role, too. Hilltop Community Resources manages numerous programs to help families live healthier lives, including programs involving car seat safety, cooking classes, domestic violence safe houses, transitional housing for former foster youth and more. SCL Health St. Mary’s Medical Center sponsors the Meals on Wheels organization that supplies meals to the elderly in Mesa County.

Lowering spiraling health care costs will require more investments of this nature by everyone in our community. We must address social determinants of health and the root causes of health inequity to practice preventive care more effectively.