Social Drivers and Immigration: How Life Circumstances Affect Health

Did you know that having a playground in your neighborhood could affect the health of people who live there? The amount of education you receive? Do you have a strong community who will support you if you need help?

The social drivers of health (SDoH) are factors that affect health. The five SDoH domains are economic stability, social and community context, education access and quality, health care access and quality, and neighborhood and built environment. 

These SDoH influence health profoundly. Studies have shown that medical care accounts for 20 percent or less of people’s health outcomes. The other 80-90 percent comes from SDoH.

How SDoH can affect health outcomes

SDoH affect everyone. Let’s look at one example.

Miguel came to the United States with his mother and father when he was a teenager. They entered the country legally, and Miguel has U.S. citizenship. He speaks English well but has a strong accent. As someone perceived as an outsider, Miguel has encountered discrimination. Though he has a college degree, he is underemployed and faces financial hardship. Because he only works part-time, his employer doesn’t provide him health insurance. He lives in a rented house, shared with his mother, brother, aunt, and two cousins. The house is on a busy street and near the highway overpass. 

These circumstances play in to Miguel’s and his family’s health outcomes. For example, Miguel has suffered from asthma since he was a child—a condition that worsened when they moved into this rented home, which has issues with mold. Miguel’s family has asked their landlord to take steps for mold removal, but when he refused, they did not push back, fearing retaliation that could target his aunt, who is living in the U.S. without legal permission. Miguel’s mom and aunt also both suffer from diabetes and have difficulty attaining insulin for his aunt. Often, Miguel’s mom and aunt share his mom’s insulin prescription.

While this example demonstrates some more obvious manifestations of the SDoH on health outcomes, others are less clear. For example, recent studies have shown that facing stress in anticipation of discrimination can cause all kinds of physical and mental health issues, including high blood pressure.

Immigration as a social driver

While everyone’s set of SDoH affects their health outcomes, immigrants to the U.S. tend to face certain circumstances that can have negative consequences on their health. In fact, one researcher comments that, “Immigration is both a consequence of the social [drivers] of health and a social [driver] in its own right,” pointing out “glaring patterns of inequality and pathogenic conditions produced by structures of poverty, immigration policy, and heavy-handed enforcement tactics.”

In other words, the situations immigrants face that are built into our systems and government can have a negative effect on health outcomes—both mental and physical. Lack of access to health care is one determinant that can make a big difference. The complexity of the medical system for someone who speaks a language other than English plays a role. 

That’s where Community Health Workers (CHWs) can make a difference. By walking alongside immigrants and helping navigate through experiences such as obtaining insurance or finding a culturally competent medical home, CHWs can alleviate some of the undue health burdens immigrants face.