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Social Determinants

Social Determinants Across the Life Stages

From infancy through old age, the conditions in the social and physical environments in which people are born, live, work, and age can have a significant influence on health outcomes.

Children

  • Early and middle childhood provide the physical, cognitive, and social-emotional foundation for lifelong health, learning, and well-being. A history of exposure to adverse experiences in childhood, including exposure to violence and maltreatment, is associated with health risk behaviors such as smoking, alcohol and drug use, and risky sexual behavior, as well as health problems such as obesity, diabetes, heart disease, sexually transmitted diseases, and attempted suicide.6
  • Features of the built environment, such as exposure to lead-based paint hazards and pests, negatively affect the health and development of young children.

Adolescents

  • Because they are in developmental transition, adolescents and young adults are particularly sensitive to environmental influences. Environmental factors, including family, peer group, school, neighborhood, policies, and societal cues, can either support or challenge young people’s health and well-being. Addressing young people’s positive development facilitates their adoption of healthy behaviors and helps to ensure a healthy and productive future adult population.
  • Adolescents who grow up in neighborhoods characterized by poverty are more likely to be victims of violence; use tobacco, alcohol, and other substances; become obese; and engage in risky sexual behavior.7

Adults

  • Access to and availability of healthier foods can help adults follow healthful diets. For example, better access to retail venues that sell healthier options may have a positive impact on a person’s diet. These venues may be less available in low-income or rural neighborhoods.
  • Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace and are increasingly affecting the health and lives of U.S. adults. Research has shown that workers experiencing these stressors are at higher risk of injuries, heart disease, and digestive disorders.8

Older Adults

  • Availability of community-based resources and transportation options for older adults can positively affect health status. Studies have shown that increased levels of social support are associated with a lower risk for physical disease, mental illness, and death.9, 10

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Disparities and Social Determinants

Race and ethnicity, gender, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. Social determinants are often a strong predictor of health disparities. For example:

  • In 2007 to 2008, the Asian or Pacific Islander population had the highest rate of high school graduation among racial and ethnic groups, with 91.4% of students attending public schools graduating with a diploma 4 years after starting 9th grade compared to rates among non-Hispanic white (81.0%), American Indian or Alaska Native (64.2%), Hispanic (63.5%), and non-Hispanic black (61.5%) populations.
  • According to the National Assessment of Adult Literacy, African American, Hispanic, and American Indian or Alaska Native adults were significantly more likely to have below basic health literacy compared to their white and Asian or Pacific Islander counterparts. Hispanic adults had the lowest average health literacy score compared to adults in other racial and ethnic groups.11
  • In 2007, African Americans and Hispanics were more likely to be unemployed compared to their white counterparts. Further, adults with less than a high school education were 3 times more likely to be unemployed than those with a bachelor’s degree.12
  • Low socioeconomic status is associated with an increased risk for many diseases, including cardiovascular disease, arthritis, diabetes, chronic respiratory diseases, and cervical cancer as well as for frequent mental distress.12
  • Low-income minorities spend more time traveling to work and other daily destinations than do low-income whites because they have fewer private vehicles and use public transit and car pools more frequently.12