HEDA [re]connection step

Education opens the doors to opportunities and resources that lead to a higher socioeconomic status or class. More education is associated with higher-paying jobs and the related benefits like financial security, health insurance, healthier working conditions, and social connections.  Education also gives us the tools we need to make informed choices about our health. People who have more years of education tend to live longer and have better health. Education also affects health across generations because children of more educated parents tend to be healthier and do better in school.

Everyone knows that without a good education, prospects for a good job with good earnings are slim.  Few people think of education as a crucial path to health, however.  Yet a large body of evidence strongly—and, with very rare exceptions, consistently—links education with health, even when other factors like income are taken into account.  People with more education are likely to live longer, to experience better health outcomes, and to practice health-promoting behaviors such as exercising regularly, refraining from smoking, and obtaining timely health care check-ups and screenings. Educational attainment among adults is linked with children's health as well, beginning early in life:  babies of more-educated mothers are less likely to die before their first birthdays, and children of more-educated parents experience better health.

Source: Robert Wood Johnson, Commission to Build a Healthier America. Education and Health, Issue Brief #5, Exploring the Social Determinants of Health, April 2011.  (Accessed July 1, 2015)

For individuals, income is one of the strongest and most consistent predictors of health and disease in public health research literature.  Research finds that people with higher incomes generally enjoy better health and live longer than people with lower incomes. The relationship between income and health consistently (although not invariably) appears as a gradient, with the poor experiencing the worst health, but also where the health of those with modest incomes is worse than the health of those with the highest incomes.  In other words, on average, the more money you make, the better your overall health. 

This relationship between health and income is not just about individual access to medical care, but how income affects a range of individual and community opportunities for health.  Individuals and communities with higher incomes are more likely to have safe homes and neighborhoods, full-service grocery stores with healthy foods, safe spaces for physical activity, and high-quality schools. As a result, those with higher incomes are more likely to live longer, healthier lives while those living in communities of poverty face conditions that lead to poor health including unsafe housing, lack of access to nutritious foods, less leisure time for physical activity, poorer education and more overall stress.

Source: Minnesota Department of Health, Center for Health Equity.  White Paper on Income and Health. 2014. (accessed 10/1/2018) 

Those with higher incomes are more likely to live longer, healthier lives. More income leads to resources that promote better health, including access to health care, nutritious food, safe housing, and nurturing neighborhoods. On the other hand, those living in poverty face a number of hardships that lead to poor health. Poverty also has a significant impact on children and can affect health across generations. Poor children are more likely to suffer poor health, affecting their ability to do well in school and eventually earn a decent wage.

Employment provides income and other resources that lead to better health. Depending on our jobs, employment can also give us a sense of purpose, social contact, and opportunities for personal growth. Conversely, unemployment has been linked to poor health, and those with lower socioeconomic status are more likely to work in occupations that have unhealthy working conditions and lack the type of benefits needed to help them stay healthy.

On average, American adults spend nearly half of their waking hours at work. Where we work influences our health, not only by exposing us to physical conditions that have health effects, but also by providing a setting where healthy activities and behaviors can be promoted. In addition to features of worksites, the nature of the work we do and how it is organized also can affect our physical and mental health. Work can provide a sense of identity, social status and purpose in life, as well as social support. For most Americans, employment is the primary source of income, giving them the means to live in homes and neighborhoods that promote health and to pursue health-promoting behaviors. In addition, most Americans obtain their health care insurance through their jobs. Not only does work affect health; health also affects work. Good health is often needed for employment, particularly for low-skilled workers. Lack of employment among those who are unable to work because of ill health can lead to further economic and social disadvantage and fewer resources and opportunities to improve health, perpetuating a vicious cycle.

Source: Robert Wood Johnson, Commission to Build a Healthier America. Work, Workplaces and Health, Issue Brief #9, Exploring the Social Determinants of Health, April 2011.  (accessed July 1, 2015)

Lower-income families who are persistently exposed to poor living conditions have higher odds of suffering from serious illnesses. Poor living conditions are usually rooted in poverty. They can include structural problems, pest infestations, mold, and toxins in the home, overcrowding, and noise, as well as pollution and crime in the surrounding area. New research has also revealed a complex relationship between homeownership and our health, with homeowners reporting better health than renters, and those in foreclosure reporting the lowest health status. Homelessness is also a growing problem that can seriously impact the health of individuals and families.

Good health depends on having homes that are safe and free from physical hazards.  When adequate housing protects individuals and families from harmful exposures and provides them with a sense of privacy, security, stability and control, it can make important contributions to health. In contrast, poor quality and inadequate housing contributes to health problems such as infectious and chronic diseases, injuries and poor childhood development.

Source: Robert Wood Johnson, Commission to Build a Healthier America.Housing and Health, Issue Brief #7, Exploring the Social Determinants of Health, April 2011.  (accessed July 1, 2015)

Along with conditions in the home, conditions in the neighborhoods where homes are located also can have powerful effects on health. The social, physical and economic characteristics of neighborhoods have been increasingly shown to affect short-and long-term health quality and longevity. 

A neighborhood's physical characteristics may promote health by providing safe places for children to play and for adults to exercise that are free from crime, violence and pollution.  Access to grocery stores selling fresh produce—as well as having fewer neighborhood liquor and convenience stores and fast food outlets—can make it easier for families to find and eat healthful foods. Social and economic conditions in neighborhoods may improve health by affording access to employment opportunities and public resources including efficient transportation, an effective police force and good schools. Neighborhoods with strong ties and high levels of trust among residents may also strengthen health. 

Not all neighborhoods enjoy these opportunities and resources, however, and access to neighborhoods with health-promoting conditions varies with household economic and social resources. Housing discrimination has limited the ability of many low-income and minority families to move to healthy neighborhoods. The concentration of substandard housing in less advantaged neighborhoods further compounds racial and ethnic as well as socioeconomic disparities in health.

Source: Robert Wood Johnson, Commission to Build a Healthier America. Housing and Health, Issue Brief #7, Exploring the Social Determinants of Health, April 2011.  (accessed July 1, 2015)

Just as conditions in our homes affect our health, the places surrounding our homes also have a relationship with our health. More than 100 years of research reveal that even after accounting for other differences among the people who live in a specific area, the characteristics of their neighborhood can be proven to impact their health. These characteristics are usually divided into three categories: physical, social, and service.

Those of us who have health coverage are much more likely to have access to regular health care, including health screenings and other preventive services that can help us avoid chronic disease. But transportation, language, and cost are also factors in accessing health care. Even if we have health insurance, it may not cover enough of the costs to make it possible to regularly access needed health care services. Access can be limited if we aren't able to get to doctor's appointments or can't communicate with our health care provider.

Access to comprehensive, quality health care services is important for the achievement of health equity and for increasing the quality of a healthy life for everyone. Disparities in access to health services affect individuals and society. Limited access to health care impacts people's ability to reach their full potential, negatively affecting their quality of life. Barriers to services include lack of availability, high cost and lack of insurance coverage.  These barriers to accessing health services lead to unmet health needs, delays in receiving appropriate care, inability to get preventive services and hospitalizations that could have been prevented.

Source: Healthy People, 2020 Topics and Objectives. Access to Health Services. (accessed July 1, 2015)

A growing body of evidence points to the fact that differences in health outcomes between racial groups are due to the differences in our lived experiences, and not to genetic differences. The primary reason for this is believed to be a long history of racial discrimination and inequality in the U.S. How groups of people are perceived and treated in society is also associated with their socioeconomic status or class.  Lower socioeconomic status translates into poorer health through social isolation and unequal access to the resources that could help us live healthier, longer lives.  Therefore, the issues of race/ethnicity, class and health are closely related.

More than 100 studies now link racism to poorer health. Many people of color experience a wide range of serious health issues at higher rates than do whites, including breast cancer, heart disease, stroke, diabetes, hypertension, respiratory illness and pain-related problems. On average, African Americans, Native Americans, Pacific Islanders and some Asian American groups live shorter lives and have poorer health outcomes than whites.

Class certainly plays a role. Because of historical discrimination and structural racism, people of color are likely to be less wealthy, to have less education and to live in segregated communities with underfunded schools, insufficient services, poor transportation and housing, and higher levels of exposure to toxic and environmental hazards. Yet socioeconomic status doesn't account for the whole picture. In many instances, African Americans and other groups fare worse than whites at the same income levels. In fact, infant mortality rates among babies born to college-educated African American women are higher than those of white Americans who haven't finished high school. Recent Latino immigrants, though typically poorer, are healthier than the average American; yet the longer they're here, the more their relative health status declines even as their socioeconomic situation improves. Racism has proven to be a factor affecting health "upstream" and independent of class.

Source: California Newsreel. Unnatural Causes: Backgrounders from the Unnatural Causes Health Equity Database. 2008. (access July 6, 2015)

Steven H. Woolf and Paula Braveman. Where Health Disparities Begin: The Role Of Social And Economic Determinants--And Why Current Policies May Make Matters Worse. Health Affairs, 30, no.10 (2011):1852-1859. Health disparities by racial or ethnic group or by income or education are only partly explained by disparities in medical care. Inadequate education and living conditions—ranging from low income to the unhealthy characteristics of neighborhoods and communities—can harm health through complex pathways. Meaningful progress in narrowing health disparities is unlikely without addressing these root causes. Policies on education, child care, jobs, community and economic revitalization, housing, transportation, and land use bear on these root causes and have implications for health and medical spending. A shortsighted political focus on reducing spending in these areas could actually increase medical costs by magnifying disease burden and widening health disparities.

David R. Williams and Selina A. Mohammed. Racism and Health I: Pathways and Scientific Evidence. American Behavioral Scientist, 57, no. 8 (2013):1153 -1173. This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of nondominant racial populations in multiple ways.

California Newsreel. Unnatural Causes: Backgrounders from the Unnatural Causes Health Equity Database. 2008. (accessed July 6, 2015). This document by California Newsreel provides an overview of how social concerns such as income, jobs, education, housing, and racism relate to health outcomes and inequities. The short pieces in this document are taken from the topic introductions in the Health Equity database on the UNNATURAL CAUSES site.

California Newsreel, Unnatural Causes Collection of Health Equity Resources. (accessed July 6, 2015). This database contains hundreds of articles, sites, video clips, charts, datasets, interviews, transcripts, and educational and outreach materials. Check back often as we will continue to add resources on a regular basis.

Robert Wood Johnson, Commission to Build a Healthier America Exploring the Social Determinants of Health, April 2011.  (accessed July 1, 2015); World Health Organization, Regional Office for Europe.  Social determinants of health. The solid facts.  Second edition (PDF). 2003 (accessed July 8, 2015) 
This publication examines this social gradient in health, and explains how psychological and social influences affect physical health and longevity. It then looks at what is known about the most important social determinants of health today, and the role that public policy can play in shaping a social environment that is more conducive to better health.

Community Tool Box:  Addressing Social Determinants of Health and Development  - University of Kansas. The Community Tool Box describes social factors that need to be addressed to improve health conditions such as economic factors, social inclusion, education, racial or ethnic bias, social norms of acceptance of particular behaviors or practices and cultural factors, influence of mass media, politics, living conditions and geography.

Centers for Disease Control and Prevention, Chronic Disease Prevention and Health Promotion.  Promoting Health Equity:  A Resource to Help Communities Address Social Determinants of Health. 2008 (accessed July 8, 2015) This workbook was created to encourage and support the development of new and the expansion of existing, initiatives and partnerships to address the social determinants of health inequities. Chapter 1 defines health equity and how social determinants influence health.  Chapters 2 and 3 describe how to work with communities to achieve health equity.

Centers for Disease Control and Prevention.  Health Disparities and Inequalities Report – United States 2011.  60, supplement (2011):1 -116 The 2011 CDC Health Disparities and Inequalities Report (2011 CHDIR) consolidates the most recent national data available on disparities in mortality, morbidity, behavioral risk factors, health-care access, preventive health services, and social determinants of critical health problems in the United States by using selected indicators. Data presented throughout CHDIR 2011 provide a compelling argument for action. The data pertaining to inequalities in income, morbidity, mortality, and self-reported healthy days highlight the considerable and persistent gaps between the healthiest persons and states and the least healthy.  Chapters of most interest include:
Education and Income --- United States, 2005 and 2009
Inadequate and Unhealthy Housing, 2007 and 2009
Unhealthy Air Quality --- United States, 2006—2009
Health Insurance Coverage --- United States, 2004 and 2008