When you think of healthcare, what do you picture? 

A shiny doctor’s office?

A white lab coat? Or nurses’ scrubs? 

Beeping machines and stethoscopes? 

For many, that list could go on and on. But it will revolve around the same ideas–doctors, medical institutions. 

But what if I told you that health and healthcare don't just revolve around doctors? In fact, traditional healthcare (doctors, pharmaceuticals) make up only 20% of our health. The other 80% is determined by the following Social Determinants of Health (SDOH).

• Housing
  • Housing is critical to health. Housing needs to be safe and accessible. It also needs to be affordable, so you have enough money left over to cover other health expenses like food and traditional healthcare. 
• Education
  • Education levels often correlate to financial status, which in turn correlates to health. Those with low academic outcomes (often seen in areas that are predominately people of color, due to funding discrimination) will often see lower incomes, leaving less money for safe housing, healthy food, and more. 
• Employment
  • Employment can impact health, based on income, benefits, and safety standards. The increased health risks of unemployment are well known, as the DC 2018 SDOH summary report notes that people who are unemployed are 54% more likely to have fair/poor health, and 83% more likely to develop stress-related conditions and other diseases.
• Transportation
  • Access to transportation is critical for connecting people to jobs, schools, grocery stores, medical facilities, daycares, and more. Those who don’t have access to adequate transportation are limited to their immediate surroundings, thus having limited opportunities for personal and career growth. 
• Food Environment
  • People need access to healthy food options. “Food deserts” – areas without access to any food within a reasonable distance– and “food swamps” – areas with access only to convenience stores and liquor stores, but not grocery stores with fresh produce, meat, etc–limit people’s ability to fuel their body the way medical experts advise. 
• Outdoor Environment
  • Environmental factors play a huge role in health. Generally, wealthier areas have more green space, parks, and are distanced from factories and pollution. In contrast, low-income neighborhoods are often in more industrialized areas, with few green areas, and with high rates of pollution. Many low-income areas struggle with high rates of asthma as a result. 
• Community Safety
  • Communities that are high in the other SDOH (good schools, high employment rates in well paying jobs, clean parks, etc) experience higher levels of community safety, while communities that lack those same resources experience higher levels of violence, posing a threat to individuals’ health. 

The key theme that comes from these SDOHs is that they are interconnected. But what might not be as immediately obvious as their interconnectedness is how they all relate to race. 

Systemic barriers connected to these SDOH routinely disadvantage people of color. Redlining and gentrification prevent people of color from accessing housing in neighborhoods that are rich in resources like daycares, well paying jobs, public transit options, green spaces and parks, and more. Convenience and dollar stores target low-income areas, pushing out family-owned grocery stories and reducing low-income neighborhoods’ access to fresh food. Employment discrimination mean many people of color are excluded from well-paying jobs because of their race or because of their education (which many can’t afford, due to race-influenced generational cycles of poverty). 

All of the Social Determinants of Health are connected, and lacking access to one often means lacking access to multiple, if not all of them. And due to the racial discrimination that many of these systems were built upon, it is people of color who are the most disadvantaged. 

Ultimately, it’s important to know that health is more than traditional healthcare. Housing is healthcare. Food is healthcare. Clean air and safe communities are healthcare. Education, employment, and transportation are healthcare. And if we want to improve public health, we have to get outside the doctor’s office.