As the League’s newest analyst with a focus on the social determinants of health, I’ve been thinking a lot about my own health and how it’s affected by the larger world in which I live. The social determinants of health are the conditions in which people are born, grow, live, work and age, and include things like environment, nutrition and income.
I took my health for granted until I was diagnosed with Crohn’s disease and prescribed medication that retails for $1,400 per month. Fortunately, I have health insurance so my medication is affordable. My disease is mostly under control and I enjoy a high quality of life, which I attribute to the fact that I’m in a position to make many choices every day that allow me to maintain good health.
Because individual behavior drives much of a person’s health status, it’s easy to blame unhealthy people for failing to make the “right” choices. However, this perspective ignores that the ability to exercise choice and make healthy decisions varies drastically from person to person, often due to broader forces beyond the control of any individual.
Many social determinants of health are closely connected to household income. Financial hardship directly prevents people from obtaining high-quality medical care, and getting and staying healthy can be costly and time-consuming in ways that disproportionately affect families that are struggling to get by.
I’m fortunate to have an employer that offers paid leave time so I don’t have to worry about losing wages due to my illness. Living in a city, I’m not too concerned about a shortage of healthcare providers. As a well-educated, white, thin person, I’m not worried that my providers harbor implicit biases affecting the quality of the care I receive. I have a reliable car so I can easily get to medical appointments and the grocery store.
Since my diagnosis, I cook almost everything from scratch. This would be impossible without access to the fresh, healthy food available at a full-service grocery store. My parents cooked regularly when I was growing up and they taught me the basics. Even with these advantages, it’s a lot of work. If I were working multiple jobs to make ends meet, I wouldn’t have the time to cook for myself and my family in this way.
I’ve never had a problem finding safe, affordable housing or had to risk my life to keep warm. As a white person who grew up in a nearly all-white town, I’ve never worried that economic structures and social institutions shaped by years of systemic racism have literally made me sick.
Poet John Donne wrote, “No man is an island.” This is especially true when it comes to health. Our well-being is intertwined with our social connections, and virtually every aspect of public policy has health implications. In a country founded on the notion of equality of opportunity, no child should be born with his or her health destiny already written in stone.
Through our policy work, the League aims to remove systemic barriers so that all Michiganians have the freedom to choose good health. Be sure to check the blog periodically as I explore the specific social determinants of health and highlight the programs and policy solutions that can empower all people to enjoy a long, healthy life.
— Julie Cassidy