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Health Problems Our Doctors Can’t Fix Alone: The Social Determinants of Health

When we are healthy, it is easy to take health for granted. We fail to notice non-events, the calamities we’ve narrowly avoided. Being able to breathe without struggle is a given until it isn’t.

This year, for five months and who knows how many more to come, we’ve gotten to experience our health in peril from up close. In the wake of this pandemic, we see how our health and the health of our communities are intertwined with education, employment, housing, income, and other non-biomedical factors, collectively known as the social determinants of healthIf you’ve never had to worry about how you’ll get your next meal, whether you can make rent next month, feared for your life when stopped by the police, or wondered if you can afford your life-saving prescription, it can be easy to let the social determinants of health go unnoticed. Health can just seem like going to the doctor every now and then, exercising, eating healthy, getting enough rest, all things you can just do on your own. Now, in this pandemic, the interconnectedness of it all is evident. No one’s health exists in isolation, and health is often about what happens outside of the hospital even more than what happens inside.

What do politics have to do with health care? Politicians determine who gets health insurance, and subsequently access to health care. Nearly 1 in 4 Americans reported putting off treatment for a serious medical condition in the past year because of cost. But seeking treatment later may result in seeking treatment when it’s too late or more serious measures are required.

A lot of time is spent in politics talking about creating and saving jobs, yet we often forget the important fact that in the US, employment is tied to health insurance and 50% of Americans are covered by their employer. This means that when someone loses their job because they’re laid off, or unable to work due to injury or illness, they face multiple layers of crisis. People are left struggling to pay rent, provide for their families, and receive appropriate medical care. 1.1 million Americans filed new claims for state unemployment last week. What your doctor could do for you doesn’t mean very much when you can’t afford to go see them because you don’t have health insurance.

The burdens of the pandemic fall disproportionately on already marginalized communities. Being told you should stay at home to stop the spread hits differently when you are homeless, or one of the millions of Americans on the brink of being evicted from their homes. The Aspen Institute estimates that 30–40 million Americans will face eviction by the end of 2020. Black and Latinx Americans constitute nearly 80% of those potential evictions. A study published in 2018 by the American Academy of Pediatrics found that families experiencing housing instability experienced worse health outcomes for caregivers and children. Housing isn’t considered a medical issue, and a house is not something your doctor can prescribe for you, but having a safe, warm place to live is essential to your health. As protest signs in New Orleans read, “You can’t wash your hands if you don’t have a sink.”

Civic Health Month is about recognizing these underlying causes for illness and disease — such as racism, sexism, homelessness and housing insecurity, income inequality, and food insecurity — as issues that no individual doctor or hospital or health system can solve. We’ve got to do this together, and that’s why we’ve partnered with hospitals and civic engagement organizations all over the country to highlight the importance of the social determinants of health, and how improving our civic health addresses these determinants.

Our healthcare workers have been referred to as the frontline; they are also often the last defense. Too often, they’re seeing patients when it has reached the worst case scenario of diabetic coma after months of rationing insulin, or being put on dialysis because they couldn’t afford medication in the earlier stages of kidney failure.

It takes physicians and allied health professions advocating for their patients’ health beyond what can be done in a medical context. It will take giving everyone a voice in our democracy and getting people registered to vote, but it will not stop there. It takes mutual aid, organizing, advocacy, protesting, donating.

Just like how our physical and mental health is shaped by numerous factors, so too is our civic health. We wear masks for our own wellbeing and to keep others healthy, especially the most vulnerable populations. Similarly, we are casting our votes not just for our own benefit, but for the most vulnerable in our communities and for the collective good of our nation.