8.1: Introduction
Health is influenced by a myriad of factors, many of them beyond genes or biology. Factors such as income and wealth, housing quality, access to greenspace, access to healthcare, education, stressful environments, and more - are often lumped into a category we call the Social Determinants of Health (SDOH). The U.S Department of Health and Human Services provides a broad definition as:
Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.
Variance in these environments and conditions that people are born into and live in cause stark differences in health outcomes. Life expectancy overall is influenced by zip code. Life expectancy at birth can vary by 10 years or more between different census tracts within the same county (NCHS, 2022). Indeed, as the Vice President of the California Endowment (a non-profit health equity advocacy group) Dr. Tony Iton states: “When it comes to health, your zip code matters more than your genetic code.” (Iton, 2021).
In this chapter we will cover health disparities and inequities, each of the different categories of SDOH, and how these determinants affect health outcomes. Although the focus of this chapter will be to cover the SDOH in the United States of America, it is important to remember that health inequities stemming from SDOH span across the globe between and within different nations and continents - each with unique and yet interdependent causes.