Author’s note: This is the first post in a series in which I’ll write about international public health disparities and societal factors contributing to public health. In these posts, I’ll delve into my journey into the field of public health, specifically focusing on eye care/visual impairments in underprivileged communities, while describing my experiences along the way.

Although the traditional approach to medicine (allopathic treatments, drugs, doctors, etc.) is clinically effective, it helps only a small population: exorbitant treatment costs often make medicine inaccessible, third-world countries are often left out by pharmaceutical providers, and sociocultural factors are often overlooked, potentially leading to misdiagnosis. Hence, current societal trends suggest that we may need to reconceptualize our approach to medicine.

We should look towards public health, rather than clinical care, to address many of these concerns. Public health places a strong focus on socioeconomic and cultural factors, known as the social determinants of health, to identify and mitigate the interconnected causes behind communal health problems. Building off of a diverse array of fields—from anthropology to sociology to public health—these social determinants seek to capture a comprehensive picture of global health in order to mitigate health disparities worldwide.

The Growing Need to Address Public Health Disparities

Health disparities around the world are far from being eliminated. For example, take the global distribution of visual impairments. The World Health Organization reports that there are 2.2 billion people with visual impairments around the world, and about 90% of uncorrected cases occur in low-income households in third-world countries; there are large disparities between the developing world versus the developed world.

Furthermore, a large percentage of people affected by visual impairments often are affected by a myriad of other factors leading to their condition: living in rural regions away from healthcare providers, a lack of communal awareness about the importance of addressing visual impairments, and numerous health conditions influenced by income level (e.g. malnutrition and diabetes). This interconnectedness provides insight into a broader paradigm: someone’s susceptibility to developing a condition can be understood through a network connecting together societal and environmental factors. Thus, effective mitigation strategies need to address the patient’s broader situation, including external factors contributing to their condition, rather than just treating the illness clinically.

The factors influencing health conditions are extensive and interconnected. For example, studies have shown that income correlates with increased morbidity as well as mortality. In addition, in certain regions of the world, there are gender-based disparities in healthcare accessibility. Geographical location (i.e., the distance to the nearest large city) also plays a role. To quantify this network, only about 20% of health outcomes are influenced by traditional medicine (medications, surgeries, hospital visits, etc.). The remaining 80% is a product of the factors mentioned above, which are known as the social determinants of health.

Social Determinants of Health

The social determinants of health are a network of factors that influence someone’s susceptibility to acquire a condition and their clinical outcomes after acquiring it. These factors are categorized into five main classifications:

Economic stability

Social and community context

Neighborhood and environment

Healthcare

Education

Social determinants of health. Source: Kaiser Family Foundation.

By stratifying and compartmentalizing a web of (potentially hundreds of) factors, the social determinants of health are a powerful tool for health providers and public health organizations. They provide community leaders a way of identifying problem areas in a community, allowing them to take specific actions for community health. For example, many poorer regions near the city of Houston, TX are food deserts and lack access to affordable healthy choices. After recognizing this, the University of Houston was able to organize healthy food banks to improve their community health—these tangible actions were only possible because of the initial recognition that the social determinants of health provided.

On an international level, the healthcare community has recently seen an increased emphasis on utilizing the social determinants of health in public health initiatives. Around the world, governments are increasingly funding social development programs to address the social factors responsible for health disparities. Addressing the social determinants of health has yielded tremendous success in the last few years, and hopefully, will be a trend that continues into the future.

Further reading:

“About Social Determinants of Health.”, World Health Organization, 25 Sept. 2017, http://www.who.int/social_determinants/sdh_definition/en/.

“For Better Health Care, Look beyond Medicine.” Optum, 8 Dec. 2018, http://www.optum.com/health-insights/social-determinants-of-health.html.

Schroeder, Steven A. “We Can Do Better — Improving the Health of the American People.” New England Journal of Medicine, vol. 357, no. 12, 2007, pp. 1221–1228., doi:10.1056/nejmsa073350.