About Dr.Chandra Bondugula


Social Determinants of Health 2

The five major Social Determinants of Health that affect our health and life expectancy are:

  • Poverty and stress
  • Lack of adequate housing
  • Education 
  • Unemployment
  • Poor access to transport and nutritious food 

According to the World Health Organization (WHO), the social determinants of health are a group of social, economic, and environmental variables that significantly impact people’s health and well-being.

More powerful influences on our health might come from the surroundings in which we are born, grow, live, work, and age.

Throughout our lives, health is impacted by social and economic situations. The likelihood of being healthy rises with financial stability—our health benefits from a reliable supply of wholesome food, secure housing, education, and employment.

People are less likely to suffer from chronic conditions like diabetes, cardiovascular disease, and depression when they have no financial hardship and have access to transportation, loving and stable relationships, a healthy diet, and care.

It also dramatically affects how people treat us and how we interact with them. For example, people get anxious and unable to handle prejudice when stressful conditions persist for a long time.

Poor health can result from racial discrimination, social exclusion, or unequal treatment. The interaction between these variables and a person’s socioeconomic status can make matters worse; it can also result from high levels of stress and a sense of no power.

In my last blog Social Determinants of Health 1, I discussed Education and Economic Stability. This blog will cover Access to Care, Neighborhood, and Social Status.


Access To Care

Access to healthcare means finding and accessing qualified healthcare providers and receiving timely medical services. 

Equity in access to care means preventive care, earlier detection of illness, and timely follow-up treatments. Further, access to primary care prevents illness and the risk of chronic diseases and thus is a vital SDOH.

But it’s not just about treating disease.

Inequity in access to care due to factors like lack of health insurance coverage, lack of transportation, and limited availability of health care providers impacts individual and public health adversely. 

Unemployment, low income, and racial/ethnic inequities affect access to healthcare services, thus influencing health equity. 

In the U.S., African Americans and Hispanics face the most significant barriers to health insurance relative to non-Hispanic Whites. Further, according to a CDC report, American Indians have high uninsured rates (28.6% under age 65 are uninsured).


Insured VS Uninsured


Insurance coverage means people can get access to affordable medical care services. They can have regular checkups for blood pressure and cholesterol levels, preventive services, and more. Thus, they are less likely to develop chronic diseases. 


People who lack insurance coverage lack access to affordable care. Thus, due to the high cost of care, they avoid or delay regular doctor visits or getting treatments. They, therefore, lack preventive care or early detection of illness. Consequently, they experience severe conditions and have to suffer huge expenses. Eventually, they are forced to spend more on expensive care treatments, for which they end up in Emergency rooms and admitted to the inpatient units. Sometimes they won’t be able to pay and can’t receive continued care to keep them healthy.


Public health

The Social determinant- access to healthcare does not address individual health only. Instead, it affects the health of a whole community. For example, vaccines help stop transmissible diseases among the public. 

In 2019, CDC recorded the highest number of cases of measles (971) in the U.S. since 1994( 963 cases). 

If those kids had better access to care, they could get timely measles vaccines. Therefore, awareness about healthcare prevention also plays a crucial role. 

Equity in Public health is possible through equity in access to care. Therefore, health equity should be the goal for public health, where all can get access and opportunities to need care. 


Neighborhood and The Built Environment

Do you live in a safe place where you can go out and exercise? Are there sidewalks or parks nearby? Do you have access to fresh food or grocery stores? 

Or do you live in an area where it’s unsafe to go out?

Neighborhoods and the built environmental conditions directly impact individual and public health. For example, the availability of fresh fruits and vegetables in the community, sidewalks, streetlights, neighborhood safety, public infrastructure, etc. 

Further, societal-level issues or neighborhoods strongly influence health outcomes such as mortality and morbidity. These social determinants of health are beyond the control of individuals. 

Low-income communities are more vulnerable to poor air, water, and environmental conditions. Further, such individuals are forced to live in areas with inadequate resources, unsafe environments, lack of transportation and care facilities, and low ecological safety and hygiene. Again, such places are more prone to natural disasters like floods, storms, and drought, posing more threats to life and affecting population health.

According to research on social determinants of health, people with stable housing facilities are more likely to be healthy. On the other hand, people with limited resources and unstable housing are more vulnerable to several health risks. For example, housing conditions, such as poor air quality and ventilation, water, mold, and pest infestation, adversely affect health outcomes and lead to asthma-related diseases. 

Low-income families are less likely to have insurance coverage or access to quality care. Thus, they are more likely to postpone needed treatment. 

Stable housing improves the mental health and health status of children and parents.


Racial discrimination

Racial discrimination is a structural injustice that has a detrimental effect on equity in health. Because of prejudice based on social class, color, ethnicity, or sexual orientation, some groups of people are devoid of proper access to health services. Even at care facilities, many people encounter prejudice or obstacles. As a result, access to care is constantly hampered by racial discrimination.

Black women are less likely to receive the proper follow-up care and have cervical cancer diagnoses before the third stage. In addition, patients with lung cancer who are African Americans are less likely to undergo chemotherapy. 

Discrimination impacts health by changing an individual’s health behaviors. It leads to poor mental health, sleep, obesity, hypertension, and cardiovascular diseases. Further, racial discrimination affects an individual’s mental health and leads to

  • Depression
  • Lower Self Esteem
  • Low Life Satisfaction
  • Distress
  • Stress
  • Anxiety

In the United States, the rate of diabetes in Hispanic Americans is three times higher than in the non-Hispanic White population. 



So, the social determinants of health all seriously impact our long-term well-being. But by identifying and addressing them at everything from the personal to the policy level, we can help ensure that people live their healthiest lives.


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