5.1 What are Social Determinants of Health?

[Slide: Social Determinants of Health: Part One]
Slide 1
Hello, my name is Janet Brishke, and today I’ll be speaking to you about social determinants of health. This presentation will be in two parts, and contain specific examples of what is being done about social determinants of health at my institution, the University of Florida Health Cancer Center. While this topic is applicable beyond the field of cancer research, there are significant implications for those living or working with cancer, and we wanted to be sure that you, as Citizen Scientists, are aware of these impacts as you work on cancer research projects.

Slide 2
This first presentation will lay the groundwork for the topic. We will start by discussing catchment areas and social vulnerability, and then move on to defining social determinants of health.

Slide 3
A catchment area is a geographic area that is served by a city, service, or institution. We see this word used most often when discussing hospitals. A hospital’s catchment area, for example, is the area served by that hospital.

Slide 4
To give you a more specific example, the catchment area of my institution, the UF Health Cancer Center [acronym used in slide title: UFHCC], is spread across 23 counties in North Florida. This includes 2.3 million people, or just under 11% of the state’s population. Our catchment area is spread over a land area of more than 17,000 square miles. And about 1 in 5 individuals in our catchment area are living at or below 100% of the Federal Poverty Level. The Federal Poverty Level is a measure of income that helps determine whether a person or family qualifies for federal benefits or programs. While we have a predominantly white population in our catchment area, 16% is Black/non-Hispanic and 9% of our population identifies as Hispanic. 23% of the population is age 65 and over. Something noteworthy about the northern part of Florida is that 44% of people have a high school degree or less- and this is a much higher percentage than the rest of the state. All of this information means that in our catchment area, we have a very vulnerable population in terms of poverty and education.

Slide 5
[Florida county map image with economically distressed counties highlighted. UFHCC catchment area is outlined with UFHCC location at center.]
Another key fact about our catchment area is that it contains 16 of the counties in Florida that have been designated as “economically distressed rural counties”. So, what does it mean to be “economically challenged” or “economically distressed”? It means that a community is suffering from factors like low income, high unemployment, and high poverty levels compared to the state averages. The state determines which areas are considered economically distressed, for the purposes of allocating resources. Looking at our specific example here, of all the counties the state has designated as economically distressed, half of them are in our catchment area. That economic distress becomes very important when we start thinking about health and the cancer care continuum from prevention to screening to linkage-to-care to survivorship.

Slide 6
[image of a small home illustrating social vulnerability]
Along the lines of economic distress is social vulnerability. This is a metric that measures a community’s resilience when faced with factors that threaten health, usually a human-made disaster like an oil spill or a natural disaster such as a hurricane. This measurement considers factors like poverty and lack of transportation, and geographic areas are then assigned a social vulnerability ranking. The federal Centers for Disease Control and Prevention, for example, use the social vulnerability rankings to determine amounts of supplies like food, water, and bedding to send to a certain area, or whether that area will require long-term support to recover, following a disaster.

Slide 7
[Florida county map showing social vulnerability across regions, with several vulnerable counties falling within the boundary of the UFHCC]
To give you a specific example from our catchment area, the darker shaded areas indicate the greatest social vulnerability, and the lighter shades are less social vulnerability. The social vulnerability calculated here takes into consideration a lot of different factors: poverty, unemployment, income, and level of education. These concepts become very important when we start talking about social determinants of health.

Slide 8
So, I’ve used this term, “social determinants of health”, but what does it actually mean, and how does it relate to what we’ve already covered? Social determinants of health are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, quality-of-life outcomes, and risks. Simply put, a person’s health can be impacted by a lot more than biological factors. This includes things like social vulnerability and economic distress.

Slide 9
[diagram showing social determinants of health, illustrating how multiple factors such as education access, built environment, and health care quality may influence one another]
This graphic helps illustrate that definition. Each of these elements plays a role, and though they may not seem interconnected, each element is impacted by the others. The maps that I showed earlier really point to the importance of understanding the social vulnerability of where your health system is, or where the researchers that you’re working with are, so that you can understand the context in which you will be engaging researchers and communities to conduct meaningful research.

Slide 10
[diagram showing how strategies and tactics at the community and individual levels influence health outcomes across upstream, midstream, and downstream stages]
We really need to be thinking about social determinants at the level of the community, or upstream. What can we do at a community organizing level, at a health policy level- but we need to remember it’s not just health policy: Educational policies, job training, and economic policies can all impact the community. So, what can we do to have a community impact? Researchers are considering and focusing on that in the studies they do, especially in cancer-related research. Moving midstream to the individual impact: how do we assess the individual and his or her family? How do we identify their individual social determinants of health? There are individual risks that they’re facing regardless of where they live. Maybe they live in an unsafe neighborhood or an area that’s economically distressed. Or sometimes, people live in neighborhoods where there’s a high degree of economic stability, but maybe they themselves are struggling to pay bills, purchase food, or pay the rent. Understanding the individual is very important. And then, we need to translate all of that into one final, downstream question: How do we address these issues to improve health and health outcomes?

Slide 11
In this presentation, we discussed that: catchment areas are geographic areas of service, social vulnerability measures a community’s resilience when facing threats to health, and social determinants of health encompass aspects of a person’s or community’s life that may impact their health or health outcomes. We will continue with this topic in the next video. See you then!