6.5 Social determinants of health
7 min read•august 20, 2024
Social determinants of health significantly impact Indigenous populations across the Americas. These non-medical factors, shaped by the distribution of resources, contribute to persistent health disparities and inequities experienced by Indigenous communities compared to non-Indigenous populations.
Economic stability, education access, social context, healthcare quality, and environmental factors all play crucial roles. Addressing these determinants is essential for improving Indigenous health outcomes and reducing disparities in the Americas.
Social determinants overview
- Social determinants of health refer to the non-medical factors that influence health outcomes and are the conditions in which people are born, grow, work, live, and age
- These determinants are shaped by the distribution of money, power and resources at global, national and local levels
- In the context of Indigenous Issues Across the Americas, social determinants play a significant role in the persistent health disparities and inequities experienced by Indigenous populations compared to non-Indigenous populations
Economic stability factors
Poverty and low income
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- is a major driver of health inequities and is associated with a wide range of adverse health outcomes, including increased risk of chronic diseases, mental health problems, and premature mortality
- Low income limits access to healthy food, safe housing, and quality healthcare, creating barriers to maintaining good health
- Indigenous populations across the Americas experience disproportionately high rates of poverty compared to non-Indigenous populations, contributing to health disparities
Unemployment and job insecurity
- and can lead to financial stress, which has been linked to poor mental and physical health outcomes
- Limited job opportunities and in hiring practices contribute to higher rates of unemployment among Indigenous populations
- Precarious employment, such as seasonal or part-time work, can also lead to income instability and difficulty accessing benefits like health insurance
Lack of affordable housing
- Affordable, safe, and stable housing is essential for maintaining good health, as it provides a foundation for meeting basic needs and accessing healthcare
- Indigenous communities often face a shortage of options, leading to overcrowding, homelessness, and increased exposure to environmental hazards
- Inadequate housing conditions, such as lack of running water or proper sanitation, can contribute to the spread of infectious diseases and exacerbate chronic health conditions
Education access and quality
Low high school graduation rates
- Education is a key determinant of health, as it influences employment opportunities, income, and health literacy
- Indigenous students often face barriers to completing high school, such as , discrimination, and cultural disconnection
- Lower educational attainment is associated with poorer health outcomes, including higher rates of chronic diseases and shorter life expectancy
Barriers to higher education
- Access to higher education can provide opportunities for better employment, higher income, and improved health outcomes
- Indigenous students may face financial, cultural, and geographic barriers to pursuing higher education, such as limited funding for scholarships, lack of culturally relevant programs, and the need to leave their communities
- Addressing these barriers and increasing representation of Indigenous students in higher education can contribute to reducing health inequities
Underfunded schools in communities
- Schools in Indigenous communities often receive inadequate funding, resulting in limited resources, overcrowded classrooms, and reduced educational quality
- Underfunded schools may struggle to provide essential services, such as school meals, counseling, and health screenings, which can impact student health and well-being
- Investing in equitable funding for schools in Indigenous communities can help improve educational outcomes and promote better health
Social and community context
Discrimination and racism
- Discrimination and can have profound impacts on mental and physical health, contributing to chronic stress, anxiety, and depression
- Indigenous populations often experience systemic racism and discrimination in healthcare settings, leading to mistrust, delayed care-seeking, and poorer health outcomes
- Addressing discrimination and racism at individual, institutional, and societal levels is crucial for promoting health equity and improving the well-being of Indigenous communities
Social exclusion and isolation
- and can lead to feelings of loneliness, depression, and reduced access to social support networks
- Indigenous communities may experience social exclusion due to geographic remoteness, language barriers, and cultural differences
- Strengthening social connections and building inclusive communities can help mitigate the negative health impacts of social exclusion and isolation
Adverse childhood experiences
- (ACEs), such as abuse, neglect, and household dysfunction, can have long-lasting impacts on health and well-being
- Indigenous children may be at higher risk of experiencing ACEs due to the legacy of colonialism, intergenerational trauma, and socioeconomic disparities
- Addressing ACEs through trauma-informed care, family support services, and community-based interventions can help promote resilience and improve health outcomes
Health care access and quality
Lack of health insurance coverage
- is a critical factor in accessing timely and affordable healthcare services
- Indigenous populations often have lower rates of health insurance coverage compared to non-Indigenous populations, due to factors such as unemployment, poverty, and eligibility barriers
- Expanding access to health insurance, including Medicaid and Medicare, can help reduce financial barriers to healthcare for Indigenous communities
Limited access to health services
- Indigenous communities, particularly those in rural or remote areas, may face limited access to healthcare facilities and providers
- Long distances to healthcare facilities, lack of transportation, and shortages of healthcare professionals can create barriers to accessing necessary services
- Investing in telemedicine, mobile health clinics, and community health worker programs can help improve access to care in underserved Indigenous communities
Poor quality of care in facilities
- Indigenous patients may experience in healthcare facilities due to factors such as cultural insensitivity, language barriers, and provider bias
- Poor quality of care can lead to misdiagnosis, inadequate treatment, and mistrust in the healthcare system
- Improving cultural competency training for healthcare providers, increasing representation of Indigenous professionals in healthcare, and incorporating practices can help enhance the quality of care for Indigenous patients
Neighborhood and built environment
Overcrowded and substandard housing
- Overcrowded and conditions can contribute to the spread of infectious diseases, exacerbate chronic health conditions, and impact mental health
- Indigenous communities often experience higher rates of overcrowding and poor housing quality due to limited affordable housing options and underfunded housing programs
- Investing in the construction and maintenance of safe, affordable housing can help improve health outcomes and reduce health disparities
Lack of transportation infrastructure
- Lack of reliable can create barriers to accessing healthcare services, healthy food options, and employment opportunities
- Indigenous communities, especially those in rural or remote areas, may have limited public transportation options and poor road conditions
- Improving transportation infrastructure, such as expanding public transit networks and investing in road maintenance, can help increase access to essential services and resources
Exposure to environmental toxins
- Exposure to , such as air pollution, contaminated water, and hazardous waste, can have detrimental effects on health
- Indigenous communities may be disproportionately impacted by environmental toxins due to factors such as proximity to industrial sites, inadequate environmental regulations, and limited
- Strengthening environmental protections, promoting clean energy initiatives, and involving Indigenous communities in decision-making processes can help reduce exposure to environmental toxins and promote environmental justice
Food insecurity and nutrition
Lack of access to healthy foods
- Access to healthy, affordable food options is essential for maintaining good health and preventing chronic diseases
- Indigenous communities, particularly those in food deserts or remote areas, may have limited access to fresh produce and other nutritious foods
- Investing in community gardens, farmers' markets, and food assistance programs can help improve access to healthy food options in Indigenous communities
Reliance on processed, low-nutrient foods
- Reliance on processed, low-nutrient foods can contribute to the development of chronic diseases such as , diabetes, and heart disease
- Indigenous populations may have higher rates of consumption of due to factors such as limited access to healthy options, , and the influence of Western diets
- Promoting traditional Indigenous food systems, increasing nutrition education, and improving the affordability of healthy foods can help reduce reliance on processed foods
Higher rates of obesity and diabetes
- Indigenous populations often experience higher rates of obesity and diabetes compared to non-Indigenous populations
- Factors such as limited access to healthy foods, physical inactivity, and genetic predisposition can contribute to the development of these chronic conditions
- Implementing culturally appropriate diabetes prevention and management programs, increasing access to physical activity opportunities, and addressing social determinants of health can help reduce the burden of obesity and diabetes in Indigenous communities
Unique challenges for Indigenous peoples
Intergenerational trauma and stress
- Intergenerational trauma refers to the cumulative emotional and psychological wounding experienced by Indigenous communities as a result of historical and ongoing oppression, violence, and cultural suppression
- This trauma can be passed down through generations, contributing to higher rates of mental health problems, substance abuse, and chronic stress
- Addressing intergenerational trauma through culturally sensitive mental health services, community healing programs, and the revitalization of Indigenous cultural practices can help promote resilience and well-being
Geographic isolation and remoteness
- Many Indigenous communities are located in geographically isolated or remote areas, which can create unique challenges in accessing healthcare, education, and other essential services
- Limited infrastructure, long distances to services, and harsh environmental conditions can exacerbate health disparities and limit opportunities for economic and social development
- Investing in telemedicine, distance education programs, and community-based services can help mitigate the impacts of geographic isolation on Indigenous health and well-being
Disruption of traditional practices
- The disruption of traditional Indigenous practices, such as language, spirituality, and land-based activities, can have profound impacts on health and well-being
- , forced assimilation policies, and the loss of land and resources have contributed to the erosion of Indigenous cultural practices and identity
- Supporting the revitalization of Indigenous languages, cultural practices, and traditional knowledge systems can help promote cultural continuity, resilience, and improved health outcomes for Indigenous communities
Key Terms to Review (41)
Access to clean water: Access to clean water refers to the availability and provision of safe drinking water that is free from contaminants and suitable for human consumption. This access is crucial for maintaining public health, reducing waterborne diseases, and improving overall quality of life. Clean water access influences various aspects of social well-being, including nutrition, education, and economic development.
Adverse Childhood Experiences: Adverse childhood experiences (ACEs) refer to traumatic events occurring during childhood that can have lasting effects on a person's health and well-being. These experiences include abuse, neglect, household dysfunction, and other forms of trauma that can disrupt a child's development and lead to various health problems later in life. Understanding ACEs is crucial for recognizing how early life stress can impact social determinants of health, including access to healthcare, education, and community resources.
Affordable housing: Affordable housing refers to residential units that are affordable for low- to moderate-income individuals and families, typically costing no more than 30% of their gross income. This concept is crucial as it directly influences economic stability, health outcomes, and overall quality of life. Access to affordable housing can reduce financial stress and improve social determinants of health by ensuring that individuals have a safe and stable place to live.
Barriers to higher education: Barriers to higher education refer to the various obstacles that prevent individuals from accessing and succeeding in post-secondary education. These barriers can be social, economic, or institutional, impacting marginalized groups disproportionately and influencing their educational and career opportunities.
Collective Identity: Collective identity refers to the shared sense of belonging and identity that a group of individuals hold based on common characteristics, experiences, or beliefs. It encompasses how individuals perceive themselves in relation to a larger community and how that perception influences their behaviors and interactions with others. This concept plays a critical role in shaping social dynamics, particularly within marginalized or historically oppressed groups, as it can foster solidarity and collective action toward shared goals.
Colonization: Colonization is the process by which a central system of power dominates the surrounding land and its components. This often involves the establishment of settlements or the control over indigenous populations, leading to significant social, cultural, and economic transformations. The impact of colonization extends deeply into aspects like health disparities and storytelling traditions, reshaping identities and experiences across generations.
Community Resilience: Community resilience refers to the ability of a community to withstand, adapt to, and recover from adverse situations, such as natural disasters, economic downturns, or social challenges. This concept emphasizes the importance of social networks, cultural identity, and local resources in building a strong foundation for recovery and growth. The resilience of a community often hinges on its ability to harness traditional knowledge, collective action, and solidarity in the face of challenges.
Cultural competence: Cultural competence refers to the ability to understand, communicate with, and effectively interact with people across cultures. It encompasses awareness of one’s own cultural worldview, gaining knowledge of different cultural practices and worldviews, and developing skills for effective cross-cultural communication. In the context of social determinants of health and educational frameworks like immersion schools and language nests, cultural competence plays a vital role in creating inclusive environments that respect and integrate diverse cultural perspectives.
Cultural Safety: Cultural safety is an approach that ensures individuals feel respected and safe within a cultural context, particularly in healthcare and social services. This concept emphasizes the importance of understanding and acknowledging the cultural identities, beliefs, and values of individuals, especially Indigenous peoples. It seeks to create environments where cultural differences are not just tolerated but celebrated, allowing for equitable access to services without discrimination or bias.
Culturally appropriate care: Culturally appropriate care refers to healthcare practices that are respectful of and tailored to the cultural beliefs, values, and needs of diverse populations. This approach recognizes the influence of culture on health behaviors, communication styles, and patient-provider interactions, emphasizing the importance of understanding and integrating cultural perspectives into healthcare delivery.
Discrimination: Discrimination refers to the unjust or prejudicial treatment of individuals based on characteristics such as race, gender, ethnicity, age, or socioeconomic status. This behavior not only affects individual lives but also has broader implications on communities and society, influencing access to opportunities, resources, and overall health outcomes.
Dr. Mary Ellen Turpel-Lafond: Dr. Mary Ellen Turpel-Lafond is a prominent Indigenous lawyer, educator, and advocate for the rights of Indigenous peoples in Canada, known for her work in social justice and health equity. Her contributions have significantly influenced the understanding of social determinants of health, especially as they relate to Indigenous communities, highlighting systemic issues that impact their well-being.
Dr. Thomas H. McGuire: Dr. Thomas H. McGuire is a prominent figure in the field of public health, specifically known for his work on social determinants of health and their impact on various populations, including Indigenous communities. His research emphasizes the connections between socioeconomic factors, access to healthcare, and health outcomes, highlighting how systemic inequalities affect the well-being of marginalized groups.
Environmental Toxins: Environmental toxins are harmful substances present in the environment that can cause adverse health effects in humans and wildlife. These toxins can originate from various sources, including industrial processes, agricultural practices, and natural occurrences, and they often disproportionately affect vulnerable populations, contributing to health disparities.
Food insecurity: Food insecurity refers to the lack of reliable access to sufficient quantities of affordable, nutritious food. This issue is often linked to various underlying factors such as poverty, social inequality, and environmental changes. Food insecurity can lead to serious health issues, especially among vulnerable populations, and is deeply intertwined with other systemic challenges like economic instability, climate change impacts, and loss of biodiversity.
Food sovereignty: Food sovereignty is the right of people to healthy and culturally appropriate food produced through ecologically sound and sustainable methods. It emphasizes the importance of local food production and control over food systems, ensuring that communities have a say in their own food choices. This concept connects deeply with health outcomes, social determinants of well-being, and the availability of healthcare services, as access to nutritious food directly impacts overall health and wellness.
Health insurance coverage: Health insurance coverage refers to a type of insurance that pays for medical and surgical expenses incurred by the insured. It plays a crucial role in determining an individual's access to healthcare services, as well as the quality of care received. The presence or absence of health insurance coverage can significantly influence health outcomes, particularly in marginalized communities where social determinants of health come into play.
High school graduation rates: High school graduation rates refer to the percentage of students who successfully complete their high school education within a specified time frame, typically four years. These rates are crucial indicators of educational attainment and are influenced by various social factors, including socioeconomic status, access to resources, and community support, which all play significant roles in determining educational outcomes.
Higher rates of diabetes: Higher rates of diabetes refer to the increased prevalence of diabetes, particularly among certain populations, often linked to various social and economic factors. These elevated rates are closely tied to issues such as access to healthcare, nutrition, socioeconomic status, and overall community health, which significantly affect the management and prevention of diabetes within different communities.
Holistic health: Holistic health is an approach to wellness that considers the whole person—body, mind, emotions, and spirit—in the quest for optimal health and wellness. This concept emphasizes the interconnectedness of various aspects of a person's life, advocating for a balance that promotes not just the absence of disease but overall well-being. Holistic health practices often include traditional healing methods, social factors, and lifestyle choices that contribute to an individual's quality of life.
Indian Health Service Policies: Indian Health Service (IHS) policies are a set of regulations and guidelines aimed at providing healthcare services to American Indian and Alaska Native populations. These policies are essential in addressing the health disparities faced by these communities, as they focus on factors like access to care, quality of services, and funding for healthcare initiatives that are culturally appropriate and sensitive to the needs of Indigenous peoples.
Isolation: Isolation refers to the state of being separated from others, which can significantly affect an individual's physical and mental health. This concept highlights how social connections or the lack thereof can influence well-being, particularly in marginalized communities where social determinants of health, such as access to resources and support systems, play a crucial role in shaping health outcomes.
Job insecurity: Job insecurity refers to the fear or anxiety about the potential loss of one's job or employment status. This concern can stem from various factors, including economic instability, organizational changes, or industry shifts, and can lead to significant stress and adverse health outcomes for individuals. The implications of job insecurity extend beyond individual workers, affecting their families and communities, particularly in relation to overall health and well-being.
Lack of access to healthy foods: Lack of access to healthy foods refers to the inability of individuals or communities to obtain nutritious and affordable food options, which can significantly impact overall health and well-being. This issue is often linked to various social factors, including economic status, geographic location, and systemic inequalities that create food deserts or limit food availability. As a result, those affected may rely on processed and unhealthy food options, leading to poor health outcomes such as obesity, diabetes, and other chronic diseases.
Limited access to health services: Limited access to health services refers to the barriers individuals or communities face in obtaining necessary healthcare due to factors such as geographic location, socioeconomic status, and availability of resources. This term highlights the disparities in health outcomes that arise when certain populations cannot easily access medical care, which is essential for maintaining overall well-being and preventing disease.
Mental health issues: Mental health issues refer to a wide range of psychological conditions that affect an individual's emotional, psychological, and social well-being. These issues can impact daily functioning, relationships, and overall quality of life, making it essential to understand how various factors contribute to their prevalence, especially in different communities.
Obesity: Obesity is a medical condition characterized by excessive body fat that increases the risk of health problems. It is typically defined using the Body Mass Index (BMI), where a BMI of 30 or higher indicates obesity. The social determinants of health significantly influence obesity rates, affecting individuals' access to nutritious food, opportunities for physical activity, and overall healthcare resources.
Overcrowded housing: Overcrowded housing refers to living situations where the number of people exceeds the available space, often leading to inadequate conditions for health and well-being. This situation can result from various factors including economic constraints, lack of affordable housing, and social inequities. Overcrowded housing can adversely affect physical and mental health, contributing to issues such as increased stress, the spread of infectious diseases, and poor overall living conditions.
Poor quality of care: Poor quality of care refers to inadequate or ineffective healthcare services that do not meet the necessary standards for patient safety, efficacy, and satisfaction. This concept is closely linked to the social determinants of health, which encompass the various conditions under which individuals are born, grow, live, work, and age, impacting their overall health outcomes. Factors such as access to resources, socioeconomic status, education, and community environments significantly influence the quality of healthcare individuals receive.
Poverty: Poverty refers to the condition in which individuals or communities lack sufficient financial resources to meet their basic needs for living, such as food, shelter, and healthcare. It is a multifaceted issue that can result from various social, economic, and environmental factors, influencing not only individuals' quality of life but also their access to essential services and opportunities for advancement.
Processed foods: Processed foods are food items that have been altered from their original form through methods like cooking, canning, freezing, or adding preservatives. These foods often contain added sugars, unhealthy fats, and artificial ingredients that can impact health. The prevalence of processed foods has significant implications on nutritional quality, dietary choices, and overall health outcomes.
Racism: Racism is the belief that certain races are inherently superior or inferior to others, often leading to discrimination and prejudice based on race. This belief system manifests in various societal structures and behaviors, impacting access to resources and opportunities, including health care, education, and economic stability. It can create and reinforce social hierarchies that disadvantage marginalized racial and ethnic groups, contributing to systemic inequalities.
Residential schools: Residential schools were government-funded, church-run institutions established in North America aimed at assimilating Indigenous children into Euro-Canadian culture. These schools sought to erase Indigenous identities by separating children from their families and communities, which had devastating impacts on cultural continuity, mental health, and social structures.
Social determinants of health framework: The social determinants of health framework is a conceptual model that identifies the social and economic factors influencing health outcomes and overall well-being. This framework emphasizes that health is not solely determined by individual behavior or genetics but is significantly shaped by conditions such as socioeconomic status, education, neighborhood environments, and access to healthcare services. Understanding these factors allows for a more comprehensive approach to improving public health and addressing health disparities.
Social exclusion: Social exclusion is the process by which certain individuals or groups are systematically marginalized and denied access to various societal resources, opportunities, and rights. This phenomenon often leads to significant disparities in health, education, and economic stability, contributing to broader patterns of inequality within a society.
Substandard housing: Substandard housing refers to living conditions that fail to meet basic health and safety standards, often characterized by inadequate facilities, poor construction, and a lack of essential services. This type of housing significantly impacts the well-being of its inhabitants, contributing to various health issues and reflecting broader social inequalities.
Traditional healing: Traditional healing refers to a holistic approach to health and wellness that incorporates cultural beliefs, practices, and spiritual elements. It often emphasizes the interconnectedness of mind, body, and spirit, and utilizes natural remedies, rituals, and community support as essential components of the healing process. This concept is deeply rooted in the cultural identities of Indigenous peoples and plays a crucial role in addressing various health challenges.
Transportation infrastructure: Transportation infrastructure refers to the physical structures and facilities that support the movement of people and goods, including roads, bridges, railways, airports, and public transit systems. This infrastructure plays a crucial role in shaping access to resources, healthcare, and social services, thereby influencing overall health outcomes and quality of life for communities.
Truth and Reconciliation Commission Recommendations: Truth and Reconciliation Commission (TRC) recommendations are proposals made by a commission established to address historical injustices and promote healing within a society, particularly in the context of Indigenous peoples. These recommendations often focus on social justice, reparations, and the acknowledgment of past wrongs, aiming to foster reconciliation between affected communities and the state. They address various social determinants of health by advocating for systemic changes that can improve the well-being of marginalized populations.
Underfunded schools: Underfunded schools are educational institutions that lack the necessary financial resources to provide adequate facilities, staff, and educational materials for their students. This financial shortfall often leads to overcrowded classrooms, outdated technology, and limited access to extracurricular programs, which can adversely affect the quality of education students receive. The challenges faced by underfunded schools are closely tied to various social factors, including socioeconomic status, race, and geographic location, highlighting systemic inequalities in educational opportunities.
Unemployment: Unemployment refers to the situation where individuals who are able and willing to work cannot find a job despite actively seeking employment. This condition has significant implications for individuals and communities, affecting economic stability, social cohesion, and overall health outcomes.