Post contributed by Aaron Katz, Skagit County Board of Health member

Social Determinants of Health.  The phrase was born out of a growing recognition that medical care is not the main ingredient in good health, despite our tendency to equate health with hospitals and doctors.  In fact, as far back as 2000 – 20 years ago! – researchers estimated that medical care was responsible for only about 10% of our health; the other 90% was mostly the product of environmental, economic, and social factors.

This isn’t surprising – I think most families know their well-being is dependent mostly on whether they have a job with sufficient income, a stable roof over their heads, adequate food, decent recreation opportunities, good relationships, and a safe environment.  Yes, medical care matters, but usually only in exceptional times. 

The Covid pandemic has opened our eyes to how “social determinants” affect us in ways that were, for many of us, invisible before:

• The structure of the job market – Who knew there were “essential workers”??  And isn’t it interesting that one feature many such workers – hospital staff, farm workers, grocery store clerks – shared was higher risk of Covid infection, because they had to work closely together or in sustained contact with the public.  And they often earned low wages and had few benefits, like health insurance or paid leave for caring for themselves or loved ones.
• Housing affordability – Every community, large and small, has struggled with assuring every person had stable housing.  Real estate prices continued to grow even during the pandemic, making it more and more difficult for especially lower income workers to live close to their work or to afford to buy enough nutritious food for their children. People without stable housing are more vulnerable to infection much less the health effects of living outdoors during our cold, wet winters.
• Supply chains – The vibrancy of our economy – as well as our health care system – depends on an intricate web of linkages that supply us with food (remember the flour shortage!), electronic parts, clothing, and toilet paper.  It doesn’t take much imagination to understand how broken supply chains like these worsen our health and well-being.

Ok, so now we can see more clearly how social determinants of health work in our communities.  But the phrase “social determinants” hides an important fact … that the factors like those I note above are neither “determinant” – as in, fated or a forgone conclusion – nor are they “social” – in the sense of being just a product of some natural way that society operates. 

Rather, these “social determinants” are very much the products of how a community shapes itself – the decisions it makes about land use, transportation, taxation, economic development, education, parks and recreation, and environmental protection and restoration. 

So, as we continue to our fight against the Covid pandemic together, we can make decisions that will strengthen our communities, for today and far into the future. If you’d like to learn more about improving health and wellness in the community and the social determinants of health, check out the Robert Wood Johnson Foundation.

Aaron Katz is a Skagit County Board of Health member and Principal Lecturer Emeritus at the University of Washington School of Public Health. Aaron received a Bachelor of Science degree from the University of Wisconsin-Madison in 1974 and a certificate (master) of public health degree from the University of Toronto in 1975.