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 health. If 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.

Have You Checked on Your Civic Health Lately?

You see your primary care doctor every year, try to eat healthy each meal (okay fine, most meals), and get a half hour of exercise each day. Those fitness tracker stats are looking great.

Physical health…check.

Maybe you do some morning meditation, talk to your therapist weekly, or take an hour a day to just focus on you. A little self care goes a long way.

Mental health…check.

But have you registered to vote? Do you trust the public institutions in your community? Have you volunteered to help your neighbors recently?

Civic health…wait what?

Yes, that’s right. Your civic health. It’s just as important as your physical and mental health, but chances are no one ever told you that. Don’t worry though — that’s what Civic Health Month is here for. Our nationwide coalition of partnering organizations, hospitals, and healthcare providers is committed to making sure you’re checking on your civic health moving forward.

Curious to learn more? Let’s get started.

Your civic health describes how well you and your community are able to participate in activities that require you to come together, solve problems, and make decisions that affect everyone. Almost anything you can think of that is considered a public issue and needs collective input or action is related to how healthy you and your community are civically.

Ready for some examples? If they were scored, any of the following scenarios would create a positive effect on your civic health, represented as a +1:

You vote in every election for the candidates and issues you care about: +1.

You’ve been to a neighborhood meeting before, such as a Town Hall: +1.

A snowstorm last winter left huge potholes in the streets that still haven’t been fixed. You call your government representatives to get them involved: +1.

You’re angry that your child’s school is underfunded. A group of parents has created a petition to send to the School Board, so you read it and sign it: +1.

Your city’s Department of Housing and Urban Development is an institution you can trust to address you and your neighbors’ concerns about lead paint in your apartment building: +1.

Almost every eligible person in your district is registered to vote because your community is committed to holding frequent voter registration events: +1.

Hopefully you’re getting the hang of it now. Civic health is vital to your own well-being and the well-being of your entire community. As members of a democracy, we are empowered to use the tools available to us — like voting, signing petitions, talking to our representatives, and taking action together — as we fight for what we believe can be better. The same way you look after your physical and mental health, you should be taking care of your civic health to make sure you are in the best position you can to do this.

Now that you know, take a second to think about the way that you engage in your community and how this affects your civic health. I’ll bet you have lots of +1’s on your list. But I doubt any of us has perfect civic health just yet, so it’s okay if you came up with some -1’s too. We’ve all got some work to do together, and today’s a great day to begin.

Why We Launched Civic Health Month

The past six months have transformed virtually every aspect of American life. COVID-19 has sent the country into a whirlwind of confusion, social-distancing and fear, requiring incredible sacrifices from many of us, including our frontline healthcare workers. The recent murders of George Floyd, Breonna Taylor and several others have reminded our country of its sordid past and present, underscoring the imperative to build a racially just future.

During this period of immense pain and uncertainty, Americans find hope in our healers: hospitals, doctors and nurses have earned a higher approval rating than any other industry since the pandemic began. These healthcare providers earn this trust every single day through their tireless work fighting COVID-19, putting their own lives on the line without hesitation to save the lives of others.

However, they are not just fighting a virus. Up to 80% of an individual’s health outcomes are determined outside of the healthcare setting due to factors such as unequal access to food, clean air, stable housing and educational opportunity. The disproportionate impact of the pandemic on Black, Brown and low-income communities is a tragic but predictable outcome of this inequality. To eliminate these disparities, we must empower patients to participate in shaping public policy — health and civic engagement are not two separate issues, but rather one and the same. As VotER Executive Director and Mass General Hospital ER physician Alister Martin puts it, “Being a healthcare provider today and ignoring civic engagement has become a lot like piloting a plane and ignoring the fact we are flying with the cabin door wide open. Our most vulnerable patients, often those from Black and Brown communities, are about to be jettisoned out into open sky. We must empower our patients to help shape policy and it starts by helping them register to vote.”

Civic Health Month takes this message to heart: our 58 and counting partnering organizations, 60+ participating hospitals and 13,000+ individual doctors, nurses and social workers are stepping up to empower their patients with the ability to vote — and vote safely — during the 2020 election.

But we are not just a coalition that ends with August.

We are an ongoing movement, and everyone is invited on this journey towards a better future. If you are a healthcare provider, talk to your patients about voting. If you are a hospital, join us as a partner. If you are a patient looking to exercise your right to vote, do your Healthy Voter Checkup to register to vote, request your mail-in ballot and encourage your friends to do the same.

Together, we are building a healthier democracy.