Where you live shouldn’t determine how well or how long you live, but it does. In fact, approximately 80% of a person’s health is determined by factors other than access and quality of clinical care.
Environmental and cultural factors make a difference. So can how much you make for a living, especially if it barely brings in enough to pay for housing, groceries or the electricity bill.
Social determinants of health are factors that influence where and how people live, learn, work and play. They provide context to a person's life and can play just as big of a role in affecting health as medications and physical lifestyle changes.
Poor housing conditions have long been associated with a wide range of health problems, including respiratory infections, asthma, lead poisoning and injuries.
The problems are apparent, the choices stark: If you can't find a stable home, your health suffers. With limited resources, if you can't afford rent, you surely won't visit the dentist. If you can't pay the electric bill, you'll put off an annual checkup. Uncertainties like these constitute what's called the "allostatic load," the physiological wear and tear caused by environmental factors.
For example, the chances of dying from heart disease or stroke are higher if you live in a county considered socially vulnerable due to factors such as crowded housing, research shows. More than 1 in 3 U.S. counties had both high heart disease and stroke death rates and high social vulnerability scores. The social vulnerability index is a measure created by the Centers for Disease Control and Prevention that incorporates 15 Census variables, including income, minority status and housing type. Those counties were clustered in the South and Midwest.
"The findings confirm what we might have imagined – that social and place-based factors play a key role in cardiovascular mortality," said lead investigator Dr. Quentin R. Youmans, a cardiology fellow at Northwestern Medicine in Chicago. "Moving forward, we have to focus on those social determinants of health just as much as we have to focus on therapeutics and other prevention measures."
Substandard housing affects many dimensions of health, according to the National Center for Biotechnology Information (NCBI), part of the National Institutes of Health (NIH). Features such as corroded water pipes, poor garbage disposal and pest infestations contribute to infectious diseases. Overcrowding, inadequate ventilation and damp, cold or moldy conditions increase the risks for chronic diseases.
Public health attention to substandard housing have waxed and waned over the years. But COVID-19 has magnified the problem. The eviction moratoria are one response to keeping people housed when faced with loss of income and mounting debt brought on by the pandemic. Black and Hispanic households have been disproportionally hard hit by job and income losses.
Another is Cinnaire's COVID-19 Resident Rental Relief Fund(link opens in new window). Delta Dental contributed $250,000 to this program, which offers temporary assistance to renters who are experiencing hardships.