Keeping It Real: A Different Approach to Discussing the Social Determinants of Health

November 26, 2019, Department, by Allison Colman

2019 December Health Wellness Keeping It Real A Different Approach to Discussing the Social Determinants of Health 410

Over the past few weeks, I’ve been thinking a lot about the language that we use in the public health sector. The language I speak of is filled with terminology, like “population-based health,” “vulnerable populations,” “socioeconomic characteristics,” or perhaps one of the most popular modern terms — “social determinants of health.” My thoughts have centered on two big questions: Is this terminology relatable to most people, or have we siloed ourselves in the public health field? And, does everyone understand “social determinants of health” and where parks and recreation has a role? After some reflection, introspection, a bit of noodling and several health team conversations, I came to the realization that (1) the language is not super relatable and this might be limiting our work, and (2) no, not everyone understands the social determinants of health and where the field of parks and recreation fits.

While one of the goals of the public health field is to unite different stakeholders, sectors and people in the pursuit of improving community health outcomes, I think that our efforts to “talk the talk” can, sometimes, have the opposite effect. When we use terms and phrases that most people aren’t connected to, we might actually be pushing them away from joining our efforts and creating even larger impacts. In the spirit of acknowledging this newfound awareness, I’m going to attempt to drop the super sexy public health language, in this case, and try to keep it real as we take a different approach to discussing the “social determinants of health.”

Health Factors and Conditions
The public health field has widely adopted the use of “social determinants of health” when we describe the different factors that can impact someone’s quality of life and longevity. In fact, I’ve probably said “social determinants of health” at least 20 times this week. But, what exactly are the social determinants of health and what role does parks and recreation play? Simply put, the social determinants of health are factors and conditions that can influence why someone may be healthy and another person may not be. They can be divided up into social and physical determinants, as well as policies.

These factors unfairly affect people living in low-income communities and people of color, reducing their quality of life and life expectancy by as much as 30 years. New research from the National Institute of Health Care Management Foundation finds that determinants influence 50 percent of health outcomes; more than health behaviors (diet, physical activity, substance use, etc.), biology (genetics, inherited conditions, etc.) and clinical care. The research finds that people struggling with food insecurity are 2.4 times more likely to go the emergency room, people living in communities that have safety concerns are 3.2 times more likely to go to the emergency room and people without reliable transportation are 2.6 times more likely to go to the emergency room. Addressing these factors is critical to improving community health and ensuring that all people have a fair opportunity to live a healthy and long life.

So, what role does parks and recreation play, and how can the field provide solutions to many of these challenges?

Neighborhood and Built Environment
Perhaps most notably, parks and recreation has a significant role to play in shaping our neighborhoods and the built environment. Quality park and recreational spaces that are accessible, properly designed with community input and well-programmed have been shown to reduce area crime and violence. Parks and green space improve air, water and environmental conditions in communities. At the same time, parks and recreation promotes access to physical activity opportunities for people to move more and provide access to healthy foods through meal programs, farmers markets and community gardens. Research demonstrates over and over again that people who live near and spend time in parks are more physically active, have improved mental and social health, are more productive and have improved focus.

Social and Community Context
Parks and recreation has an exceptional ability to bring people together. In my nearly five years at NRPA, I’ve been on dozens of site visits. And while programs and facilities differ, there is one thing that is consistent across the field. Nearly every program participant I talk to tells me that the biggest benefit of parks and recreation is the socialization that it provides. They are public spaces and places, open and welcoming to all. They provide an opportunity for people from different walks of life to connect through shared experiences. They also provide an opportunity for civic engagement and participation. Parks and recreation is a driving force of social cohesion in all communities.

While these are just a few examples of how parks and recreation can address the social determinants of health, the opportunities are endless. Local agencies across the country are tackling so many of these challenges — from establishing partnerships with healthcare providers, to referring patients to chronic disease interventions, providing Supplemental Nutrition Assistance Program (SNAP) enrollment assistance at park and recreation sites, installing green stormwater infrastructure in parks to mitigate flooding and improve water quality, and by establishing policies that ensure these resources are being invested in the communities that need them most.

As a public health professional, I, obviously, agree that there is a time and a place to talk the talk, but it’s also important to bring more people into this work to continue making progress. So, to relate to others outside of the public health sector, I challenge you to take time to connect with your colleagues, policymakers and the people you serve in your communities. Have a conversation about the work your agency is currently doing to improve neighborhoods. And, try to keep the public health language to a minimum. You never know who might hear something they connect with and join the fight.

While often listed and described differently, examples of social determinants and underlying factors (as listed in the Healthy People 2020 framework) include:

  • Economic stability
  • Employment
  • Food Insecurity
  • Housing Instability
  • Poverty
  • Education
  • Early Childhood Education and Development
  • Enrollment in Higher Education
  • High School Graduation
  • Language and Literacy
  • Social and Community Context
  • Civic Participation
  • Discrimination
  • Incarceration
  • Social Cohesion
  • Health and Healthcare
  • Access to Healthcare
  • Access to Primary Care
  • Health Literacy
  • Neighborhood and Built Environment
  • Access to Foods that Support Healthy Eating Patterns
  • Crime and Violence
  • Environmental Conditions
  • Quality of Housing

Allison Colman is NRPA’s Director of Health.