Chapter Summary

Economically stable individuals and families have a steady source of income with consistent access to the resources that are essential for a healthy life, such as food, clothing, safe housing, transportation, quality child care, quality education, and health insurance. Almost 12 percent of the U.S. population lives in poverty and experiences economic insecurity. BIPOC communities comprise half of the individuals who are economically insecure, and the cycle of poverty often persists across generations. Poor health outcomes, including early cardiovascular disease, metabolic disease, diabetes, and mental health disorders, are directly linked to living in poverty, illustrating the concept of the socioeconomic gradient.

Neighborhoods and the built environment, including the quality and safety of water, air, and soil, the quality and safety of the community’s infrastructure, housing, transportation, and roadways, and access to healthy foods that support positive eating patterns, directly impact health. Locations with limited options for affordable and healthy foods are considered food deserts. Neighborhood safety is a huge public health concern. ACEs are more likely to occur in lower-income communities; are linked to lifelong mental illness, chronic disease, and substance use; and negatively impact education and future earning power. Housing quality is an important determinant of health, as lead, mold, asbestos, vermin, and even crowded living conditions are all modifiable environmental risk factors associated with poor health outcomes.

Education is one of the most important modifiable SDOH; increased educational attainment is associated with an increase in healthy lifestyle behaviors and improved health outcomes. Individuals living in impoverished neighborhoods often have less access to community resources, such as high-quality schools, resulting in significant disparities in educational opportunities. Quality early childhood education programs can help reduce educational gaps, but access remains an issue. Fostering quality, accessible, and affordable early childhood education programs can positively impact educational attainment levels. Encouraging and assisting all students to achieve a high school diploma is associated with better employment opportunities and higher-paying jobs, resulting in overall improved health.

Positive community relationships and civic participation can help buffer the negative impact of unsafe neighborhoods, poverty, and discrimination. Social capital is associated with more physically active, happier, and healthier lives. Discrimination in any form is a public health threat. Structural discrimination is at the root of health disparities seen in BIPOC individuals. The SDOH are intricately tied to structural discrimination, racism, and persistent health disparities. High levels of social support positively influence health outcomes and decrease the incidence of social isolation and its negative impact on mental and physical health.

The SDOH have a greater influence on health outcomes than clinical care. Racism and other SDOH are central drivers of health disparities and inequities within BIPOC communities, creating inequities in access to housing, education, wealth, and employment, thereby placing these individuals at higher risk for poor health. Equity is needed to address the historical injustices that have perpetuated structural racism and discrimination. To influence the health of a population, it is necessary to focus on improving social conditions and addressing the SDOH. To reduce health disparities, individual needs must be addressed holistically. The Future of Nursing 2020-2030 report highlights health equity as a major focus for nursing, and this begins with assessing the SDOH with every client encounter.