Social and economic factors have a greater impact on our health than the actual health care we receive. We’re learning more and more about the importance of social determinants of health (SDoHs) ‒ the social, economic, environmental and personal factors that largely determine the quality of our health.
SDoH are the conditions in which we are born, live, learn, work, play, worship and age. Experts tell us that the ZIP Code where we’re born is a stronger determinant of our long-term health than our genes or the health care we receive. SDoH include income, social status, employment and working conditions, education, adverse childhood experiences (ACEs), social support network, housing and neighborhood, and access to health services. They also include behaviors such as smoking or not exercising, our race, genetics and gender.
If we want a healthier population, a more productive workforce and lower health care costs, we need to pay much closer attention to SDoH. They determine more than 80% of our health outcomes, while medical care has a small (10-20%) impact.
Nutrition is one of the strongest SDoH and one that is modifiable. A recent nutrition study from Tufts University reveals the enormous cost of poor diets. The United States spends $50 billion a year on treatment for just four health problems: heart disease, stroke, type-2 diabetes and related cardiometabolic diseases. Poor diet is also linked to cancer, obesity, tooth decay, anemia, osteoporosis and other chronic conditions. Because many of these diseases are preventable, that $50 billion in health care spending might have been prevented. Instead, every Americans’ health care costs increase by $300-$536 per year, depending on age.
The food we eat depends on accessibility and affordability far more than it does on personal food choices. Twenty years ago, Arkansas had almost twice the number of grocery stores. Now there are five or fewer grocery stores in 65% of Arkansas counties. Food deserts are increasingly common in rural and low-income areas.
If you live in a food desert without access to grocery stores offering fresh produce and other healthy choices, or do not have transportation to regularly shop for food, you are “food insecure.” Food insecurity means a person is unsure where their next meal is coming from or they don’t have enough food to maintain their health. If you cannot afford nutritional food, or have no way to store or cook it, you live with food insecurity. Your choices are limited to convenience store snacks and low-nutrition, ready-to-eat food or fast-food outlets.
While there are many public and private feeding programs to combat hunger ‒ from free school lunches and food stamps (SNAP), to food banks, farmers’ markets and WIC, which helps pregnant women and infants ‒ the number of people who are food insecure continues to increase. At least 40 million Americans live with food insecurity every day.
The widely held belief that unhealthy food is cheaper is not true. The most comprehensive study about food costs concludes that unhealthy foods ‒ fast foods and processed foods high in saturated fats and sugar ‒ are about $1.50 cheaper per day, per person, compared to healthy food. That’s about $550 a year more. However, the extra cost could be offset by avoiding the costs of poor diet-related health care costs of $300-$536, identified by the Tufts’ research.
A number of SDoH initiatives are underway and the short-term results are clear. Better living environments produce better health, lower mortality, and save money for consumers, employers who provide health insurance and taxpayers, through lower public-health benefit costs.
If you’re looking for a New Year’s resolution that’s a win-win for your business and employees, consider being an advocate for better nutrition. Raise awareness with your legislators, city council, policy makers and community leaders. Government can help with zoning code flexibility, economic or tax incentives to improve existing or new food retailers, and bus routes that provide easier access to grocery stores.
The American Public Health Association recommends that doctors regularly screen patients for food insecurity and refer to community food resources, as appropriate. The Association’s “Health in All Policies” (www.apha.org) shows how all sectors of the community can work together to improve health and support job creation, economic stability, transportation access and educational opportunities.
The Arkansas Center for Health Improvement recommends: “… financial incentives for small grocery stores and convenience store enhancements, farmers’ markets, mobile markets, food hubs and cooperatives can bring healthy food retail opportunities into food desert areas.”
The Arkansas Department of Health’s Healthy Active Arkansas initiative (https://healthyactive.org/) describes how communities and neighborhoods can make it easier to eat healthy.
Resolve to make a real difference in the lives of all Arkansans this year. Let’s work together to make sure no one goes hungry.
Editor’s note: Ray Hanley is president and chief executive officer of the Arkansas Foundation for Medical Care (AFMC), a nonprofit health care improvement organization.