Social needs and social risks: How environmental factors affect health

“In the United States, structures have been created to benefit those who are in power,” which means that people who are not in power face additional hardships that can affect their health, says Tiffany White. White is the Health Programs Manager, Healthy Communities Program, Cincinnati Health Department. She facilitates the Live-Work-Play Cincinnati Coalition.

“Live-Work-Play is a multi-sector coalition that works to improve health outcomes through social needs,” White says. “Community partners meet monthly to discuss different topics that are geared toward addressing the social determinants of health,” which are the environmental factors—good and bad—that affect every person’s health outcomes.

Community partners involved in the coalition include Health Care Access Now, the Health Collaborative, bi3, Cradle Cincinnati, the American Heart Association, and many more. “The coalition works together and with neighborhood councils, managed care plans, and other community resources, such as La Soupe.”

Working to improve community conditions

White recently changed roles within the health department; she previously worked with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), meaning maternal and infant health was her primary focus. 

“It’s a huge indicator of health status in the community. Black women are three times more likely than their white counterparts to die in childbirth. That’s directly related to built environment, socioeconomic status, and access to health care.”

Birthing parent and infant mortality rates clearly demonstrate the health inequities suffered by historically marginalized populations. And the Live-Work-Play Coalition works to improve community conditions that can exacerbate health issues all throughout people’s lives.

For example, the fire department was a recent Live-Work-Play coalition meeting presenter, educating coalition partners about how the fire department helps community members increase safety, so that partners can impart this information in their outreach. This includes safe space heater usage, installation and maintenance of smoke detectors, and correct car seat installation. 

“The fire department provides this education directly to communities based on demand—but the only neighborhoods that have requested it are among the most affluent in the city,” says White, adding that this situation is a microcosm of the way social resources wind up being distributed. The coalition is working with the fire department to develop flyers and advertising for proper car seat installation so that the information can be more equitably distributed in the community. This, White says, is one of the coalition’s mandates: to raise awareness of existing resources.

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Economic insecurity and social determinants of health

“Systems are built to be profitable,” says White, adding that the housing sector demonstrates how that creates unhealthy conditions for financially unstable people. “Both the location and the quality of housing available to low-income families affects their health,” she says. 

Food deserts and food swamps (defined as an area with few grocery stores, but many non-nutritious options for procuring food, such as convenience stores and fast-food restaurants) are more likely to be neighborhoods where low-income people reside, for example. 

“When people have lower access to quality protein, whole grains, and produce, and they have a higher intake of saturated fat, they have higher risks of chronic disease, such as hypertension, heart disease, and cancer.”

Not only that, but low-income neighborhoods are more likely to have environmental exposures, such as poor air quality and lead exposure, which can impact long-term health. “The housing itself can cause some of those issues,” White says.

Those are but a few examples of the ways in which financial instability can influence health. And stress—which is a major issue for low-income families—compounds health challenges by increasing allostatic load (wear and tear on the body), “which has a huge impact on your body function and can lead to chronic disease.”

White says, “Children who are raised with a high allostatic load tend to cycle back into the same story and are unable to access the steppingstones out of poverty. They have no safety net.” 

She also points out that the focus of many nonprofits, activists, and community resources has been on finding pathways for individuals to climb out of poverty, rather than on figuring out ways in which the long-term burdens of negative social determinants of health can be decreased. 

“We need to listen to [community members’] actual needs and then analyze policies, environments, and systems that are creating vulnerabilities. Then, we can look at areas of opportunities to work with community partners.”

Changing the structures so that they are not solely benefiting those in power can have a profound positive effect on the health and wellbeing of all people.