Written by Rachel Crumpler
Access to food. housing. education. Employment security. climate change.
These and other non-medical factors that shape where people are born, live, and work have become known as social determinants of health. And while they are not connected to the healthcare system, they certainly have an even greater impact on people's health, well-being, and daily lives.
In recent years, the public health community has become increasingly aware of how these factors influence population health and contribute to widening health disparities. Addressing the social determinants of health is therefore a key focus of Healthy People 2030, a national goal to improve health and well-being.
In North Carolina, state health leaders stepped up. Using the state's Medicaid program, the company launched the nation's first project, the Healthy Opportunity Pilot, in 2022 to address people's non-medical health needs by providing healthy options. By paying a food box or someone's first month's rent.
The Minority Health Conference, the 45th annual student-led conference at UNC-Chapel Hill's Gillings School of Global Public Health, focused on the topic Friday with the theme “Buildings for Well-Being: The Relationship between Health and Stress.” I guessed it. ” More than 900 people (nearly 700 in person and a further 230 online) spent the day exploring the role of social determinants of health, particularly the mental and physical stress associated with them, and the disproportionality they bring. learned about short-term and long-term effects. It targets underprivileged people of all ages.
“Stress is physically ingrained in our bodies, impacts our risk of chronic disease, and can impact not only our lives, but the lives of our families and communities,” said Coordinator of the event. said Raven Walters, co-chair of the Minority Health Conference, which helped. . “With this in mind, promoting equity related to social determinants of health becomes even more important for public health practice.”
Impact on early childhood development
Iheoma U. Iluka, founding director of the Equity Research Action Coalition at UNC-Chapel Hill's Frank Porter Graham Child Development Institute, spoke at the conference. She said that children are shaped by their environment and surroundings from an early age.
The first 1,000 days of life are when children develop neural pathways based on what they observe and feel. Ilka said this is a particularly sensitive period of development that many people underestimate.
“People think that children live in a bubble,” Iruka said. “You go home, you go to school, and that's it. But with police violence and political unrest, the kids are really feeling the world. They start feeling the feelings of their families. It's like when I'm stressed, when I'm feeling something, and me and my husband are talking about it, my kids are listening to it. They feel it. They feel the community. They feel the tension. They literally internalize it.”
For example, Iluka said political forces such as book bans across the country send a harmful message to children.
“Imagine saying to a child, 'That book that's written about you, about your people, about your community, has no value.' I'm going to ban it.” , it tells you what’s not worth it,” she said. “Now you get the story right away. It's actually inhumane and it's actually not healthy.”
Mr. Iluka argued that ongoing racism, prejudice and discrimination are harming the lives of young children and quietly killing them.
She has seen her daughter affected. When Iruka was 3 years old, she said, she was shocked when her daughter came home from school and said, “Mom, I don't know if she really likes this skin.”
Iruka has tried to instill self-love and a love of black culture in her children from birth, but she has also struggled with societal prejudice and the various forms that children can internalize at an early age. Exposure to racism helped defeat that, she said.
Children manage to get through their days, but changes in their environment change and damage them. Ilka also added that there is a link between racism and adverse childhood experiences. Adverse childhood experiences (ACEs) are traumatic events such as witnessing domestic violence, experiencing abuse or neglect, or even seeing a loved one sent to jail or prison. Research shows that these experiences put people at increased risk for more severe physical and mental health problems as they age.
The study also shows that racial and ethnic discrimination is almost seven times more common in children with the other three ACEs compared to children without other such events.
Iruka said children need to be protected from the harm of these social stressors, and one of the most important buffers against social trauma is ensuring that children have safe and supportive caregivers and adults. He said that it is important to know.
“They're part of a larger family system. They're part of a larger community,” Ilka said.
He continued that policymakers need to think about what they are doing not only from the child's perspective, but also from the family's perspective.
“If the family is doing well, the children will be OK,” she insisted.
Factors get under the skin
Chantel Martin, a professor in the Gillings College of Epidemiology, also discusses how exposures in the social and physical environment become biologically embodied, or penetrate beneath the skin and influence health outcomes. I talked about that.
Despite decades of advances and improvements in medicine and technology, Black Americans continue to have poor health outcomes at every stage of life, from birth to early death, Martin said. said. Additionally, black adults have the physiological profile of white adults who are six to 10 years older, she said.
In fact, black adults are aging faster, she says.
Martin explained that these differences exist even when individuals behave similarly, suggesting that more factors are at play. For example, black and white women with the same educational background have significantly different mortality rates and ages at death. One clear contrast is that the pregnancy-related mortality rate for white women with less than a high school diploma is lower than the mortality rate for black women with a college education.
“Education and social support do not have equal health benefits,” Martin says. “For black women, achieving higher levels of education and having more social support alone does not lead to improved health outcomes.
“To me, this speaks to the conditions and environments that Black women have to overcome in order to receive a high level of education that may be unhealthy. and are exposed to other stressors such as racism, discrimination, microaggressions, and gender-based racism due to the intersection of being a woman.”
Environmental context, the context that creates and reinforces stressful situations, is essential to understanding differences in health, Martin argued. Areas where violence, poverty, political disenfranchisement, environmental toxins, and other conditions exist can trigger biological stress responses that influence health outcomes.
Martin cited her own research that looked at whether exposure to neighborhood violent crime in Durham during pregnancy affects the child's health after birth, and that the effects occur even before birth. He said it was possible. The study found that black and Hispanic women were exposed to a violent crime every 1 1/2 to 2 weeks during pregnancy, while white women were exposed to a violent crime once every few months. . For each additional violent crime in a neighborhood, black children's blood pressure rose during childhood.
Additionally, Martin explained how biological stress responses influence the aging process. Although chronological age is a measure of chronological time since birth, it is more accurate for the aging process that it depends on cardiovascular activity, metabolic function, how a person's genetic makeup is expressed physically, and other stressors. A person's biological age as measured by markers. Biological aging can occur at different rates in different groups due to different circumstances, conditions and exposures, Martin said.
Based on data from Detroit neighborhoods, Martin and other researchers found that people who live in areas with high levels of social disorder and increased poverty may experience an additional two years or more of aging in their bodies. I discovered that.
overcome stress
Public health researchers and leaders are working to address health inequities, but they also recognize that the work itself can be a stressful workload.
“This job is hard to do,” Martin said. “It's disgusting to realize that organizations and people in power and what's going on to prevent us from doing this work, to discredit our work, to discourage us from doing our work. . I'm tired.
“Sometimes I want to throw up my hands and say, 'Nothing's going to change!' But I know that's not true, because I know that things change and can change. Because we have a history to show for it.”
Walters and Sierra Thomas, the event's lead student organizer, hope the day's conference will give participants an opportunity to self-reflect on the social determinants and stressors of their own health. there was.
“hoping [the conference] As public health workers, we are working hard within public health and within the profession to promote access to the social determinants of health, reduce the negative effects of stress, and collectively build a better future for all of us. Both will spark important conversations about how we can collaborate with others. ” Thomas said.
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