Key Factors Influencing Health Outcomes

Why This Matters

When you're tested on health outcomes, you're not just being asked to list factors that affect health—you're being asked to demonstrate understanding of how social, economic, and environmental conditions create systematic patterns in who gets sick and who stays well. The concept of social determinants of health is foundational to contemporary health policy, and exam questions will push you to connect individual factors to broader systems of inequality, access, and opportunity.

Think of these factors as interconnected gears rather than isolated items. Income affects housing, which affects environmental exposure, which affects chronic disease rates. Education shapes health literacy, which determines how effectively someone navigates the healthcare system. Your job is to see these connections and explain why certain populations experience worse health outcomes—not because of individual choices alone, but because of structural conditions. Don't just memorize the factors; know what mechanism each one illustrates and how they compound to create health disparities.

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Economic and Material Resources

The most fundamental determinants of health are material: do people have enough money, stable work, and adequate housing to meet their basic needs? These factors operate through multiple pathways—direct access to goods and services, chronic stress from financial insecurity, and neighborhood conditions that either support or undermine health.

Income and Socioeconomic Status

• Higher income directly enables health—affording nutritious food, safe housing, gym memberships, and out-of-pocket medical costs that lower-income individuals cannot access
• Socioeconomic status creates a gradient effect, meaning health improves at every step up the income ladder, not just above a poverty threshold
• Economic instability triggers chronic stress responses that elevate cortisol levels and contribute to cardiovascular disease, diabetes, and mental health disorders

Employment and Working Conditions

• Job quality matters as much as job status—hazardous conditions, lack of autonomy, and unpredictable schedules all independently harm health
• Employment determines insurance access in the U.S. system, creating a direct link between work status and healthcare availability
• Unemployment and job insecurity produce measurable health declines through both material deprivation and psychological stress pathways

Housing and Neighborhood Conditions

• Housing is a health intervention—stable, affordable housing reduces emergency room visits, improves medication adherence, and lowers mortality rates
• Physical housing conditions directly cause illness through lead exposure, mold, pest infestations, and temperature extremes
• Neighborhood built environment shapes behavior through access to parks, sidewalks, grocery stores, and exposure to violence or pollution

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Knowledge and Navigational Capacity

Health outcomes depend not just on resources but on the ability to use them effectively. Education and health literacy determine whether individuals can understand health information, communicate with providers, and make informed decisions about prevention and treatment.

Education

• Educational attainment is one of the strongest predictors of life expectancy—each additional year of schooling correlates with measurably better health outcomes
• Education operates through multiple mechanisms: higher earning potential, better health literacy, enhanced problem-solving skills, and expanded social networks
• Critical thinking skills gained through education help individuals evaluate health claims, resist misinformation, and advocate for themselves in medical settings

Health Literacy

• Health literacy means more than reading ability—it includes numeracy skills to understand dosages and risk statistics, plus system navigation skills
• Low health literacy costs the U.S. healthcare system billions annually through preventable hospitalizations, medication errors, and delayed diagnoses
• Shame and concealment often accompany low health literacy, causing patients to avoid asking questions or admitting confusion to providers

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Access and Structural Barriers

Even when individuals have resources and knowledge, structural barriers can block their path to health. These factors highlight how systems—healthcare, transportation, food distribution—either facilitate or obstruct health-promoting behaviors.

Access to Healthcare Services

• Availability, affordability, and acceptability are the three dimensions of healthcare access—lacking any one creates unmet health needs
• Insurance coverage is necessary but not sufficient—high deductibles, narrow networks, and provider shortages still create barriers for the insured
• Preventive care access is especially critical because early intervention prevents costly, debilitating conditions from developing

Transportation Access

• Transportation is a hidden determinant that affects every other factor—you can't use healthcare, healthy food, or employment if you can't get there
• Missed appointments due to transportation lead to disease progression, emergency department use, and worse outcomes across conditions
• Transportation barriers concentrate in rural areas and low-income urban neighborhoods, compounding existing disadvantages

Food Security and Nutrition

• Food insecurity affects 1 in 8 Americans and is strongly linked to diabetes, hypertension, and depression
• Food deserts—areas lacking affordable, nutritious food options—force reliance on convenience stores and fast food
• The stress of food insecurity itself harms health independent of nutritional intake, through anxiety and difficult trade-offs between food and other necessities

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Social Connection and Support

Humans are social beings, and isolation is a health risk factor comparable to smoking. Social networks provide emotional support, practical assistance, information sharing, and a sense of belonging that buffers against stress and promotes health behaviors.

Social Support Networks

• Strong social ties reduce all-cause mortality by approximately 50%, making relationships one of the most powerful health determinants
• Support networks function practically—providing rides to appointments, help during illness, and information about health resources
• Social isolation triggers inflammatory responses and is associated with increased rates of heart disease, stroke, and cognitive decline

Social Exclusion and Discrimination

• Exclusion operates through material and psychological pathways—limiting access to jobs, housing, and services while also causing chronic stress
• Discrimination is a form of chronic stress that accumulates over a lifetime, contributing to accelerated aging and earlier onset of chronic disease
• Internalized stigma can lead individuals to avoid healthcare settings where they expect mistreatment, delaying necessary care

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Identity and Systemic Inequity

Certain characteristics—race, ethnicity, gender—are associated with health disparities not because of biological differences but because of how society treats people based on these identities. Understanding this distinction is critical for exam success.

Race and Ethnicity

• Racial health disparities persist even when controlling for income and education, indicating that racism itself—not just socioeconomic status—harms health
• Weathering hypothesis describes how chronic exposure to discrimination accelerates biological aging in marginalized groups
• Healthcare system bias produces differential treatment, with studies showing Black patients receive less pain medication and fewer referrals for advanced procedures

Gender and Gender Identity

• Biological sex affects disease risk and presentation, but gender—the social construct—determines access, treatment, and health behaviors
• LGBTQ+ individuals face elevated rates of mental health challenges driven by minority stress, discrimination, and family rejection
• Gender-affirming care is a significant health intervention, with access linked to dramatically improved mental health outcomes for transgender individuals

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Developmental and Environmental Foundations

Some health determinants operate before individuals can make any choices at all. Early childhood experiences and environmental exposures set trajectories that shape health across the entire lifespan.

Early Childhood Development

• The first 1,000 days (conception through age 2) establish neural architecture, immune function, and stress response systems that persist into adulthood
• Adverse Childhood Experiences (ACEs) show a dose-response relationship with adult disease—more ACEs predict higher rates of heart disease, cancer, and mental illness
• Early intervention programs like home visiting and quality childcare produce measurable health benefits decades later, making them cost-effective investments

Environmental Factors (Air and Water Quality)

• Environmental exposures cause an estimated 25% of global disease burden through air pollution, contaminated water, toxic chemicals, and climate-related events
• Environmental injustice concentrates hazards in low-income communities and communities of color, compounding existing health disparities
• Lead exposure remains a critical issue, causing irreversible cognitive damage in children even at low levels previously considered "safe"

Stress and Mental Health

• Chronic stress dysregulates the hypothalamic-pituitary-adrenal (HPA) axis, leading to sustained cortisol elevation that damages cardiovascular, immune, and metabolic systems
• Mental health conditions are both causes and consequences of other health problems, creating feedback loops that worsen overall health
• Structural stressors—poverty, discrimination, housing instability—are more damaging than acute life events because they're persistent and often uncontrollable

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Quick Reference Table

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Self-Check Questions

1. Which three factors operate primarily through material pathways (direct access to resources), and how do they differ from factors that operate through psychosocial pathways (stress and social connection)?

2. Compare and contrast how education and health literacy influence health outcomes. Why might improving health literacy be a more immediate policy intervention than improving educational attainment?

3. If an FRQ asks you to explain why racial health disparities persist even when income is equal, which factors would you emphasize and what mechanisms would you describe?

4. How do early childhood development and environmental factors both demonstrate the concept of "upstream" determinants? What makes interventions at this level particularly cost-effective?

5. A community has high rates of diabetes despite a new clinic opening nearby. Using at least four factors from this guide, explain what barriers might still prevent residents from achieving better health outcomes.