The greatest advantage a physician has to effectively treat symptoms and their causes is the ability to directly observe and interact with patients. Too often, however, the circumstances preceding and following a consultation may be beyond a physician’s firsthand knowledge or ability to help control. This is because the social, political and economic factors that face patients can have as much — if not more — of an influence on a patient’s well-being than whatever physical health concerns bring them in for an office visit.
These social determinants contribute to health and health care disparities in multiple ways. Upstream determinants, such as policy and governance, determine how downstream determinants — including access to health care, risk behaviors, education and community conditions — affect disadvantaged populations. There are also a number of contributing factors, some of which are uncomfortable to address, that must be overcome before real change can happen. These include discrimination, income and education levels, occupation and availability of health care access.
The current COVID-19 crisis has cast a brutal light on these disparities. Racially and ethnically diverse low-income areas had infection rates nearly eight times higher in early months. These imbalances have led to multiple professional organizations to call for recognition of how social determinants of health contribute to inequities in health care among vulnerable and disadvantaged communities and to demand action at individual, organizational and policy levels.
This is a real problem. In 2000, more than 16 percent of U.S. deaths (n=400,000) were attributed to poor diet and physical inactivity. In roughly that same time period, the rate of obesity increased by nearly 12 percent. The immediacy of mortality from obesity may not compare to the current pandemic, but the outcomes are undeniably similar. Food insecurity, which impacted around 37 million people before the pandemic is anticipated to rise to closer to 54 million people. Combine this number with poor nutrition, and the unfortunate, yet probable result becomes clear: People who are already at high risk become even more vulnerable to obesity and other diseases.
Understanding the social determinants that affect weight allows clearer focus on the development of all types of evidence-based programs to help shift financial support and access to a range of programs that reduce incidents of obesity before they become a costly health issue. This includes education on various weight loss options, including meal replacements. Research increasingly recognizes that a one-size-fit-all approach to diet is ineffective.
Successful weight loss and maintenance only occurs when participants are compliant. So providing options is critical to individual success.
The benefits of healthy communities extend far beyond the physical parameters of any neighborhood. Providing access to health care, food and other needed resources demands commitment from hospitals, health care providers, insurers and governments, as well as those who have or are at risk for obesity. Acknowledging gaps in health care accessibility and addressing the social determinants that contribute to them is the first step and it must be taken now.