You may have heard the term “social determinants of health” but not known exactly what it meant. Put simply, social determinants are the factors that determine how easy or hard it is for someone to get good medical care and live a healthy life.
Take heart health, for example. A person’s heart health is affected by family history, but it’s also determined by lifestyle factors, including nutrition, exercise, smoking, and regular preventative care. These are considered “social determinants.”
Factors such as being unemployed, having a low-income job, having little education, or living in an economically challenging neighborhood can all affect a person’s ability to:
- Find and afford fresh, healthy food
- Live in safe and adequate housing
- Get to and from a hospital, doctor’s office, or pharmacy
- Pay for doctor’s visits, treatment, and medication
Social determinants of health also include things like education levels, the neighborhood and physical environment in which a person lives, and their access to social support.
Heart Health Is Not Equal
Heart disease is the leading cause of death for both American women and men. It is, however, deadliest among Black Americans. Black men die from heart disease at 1.2 times the rate of white men and Black women at 1.3 times the rate of white women.
“Let’s use West Philadelphia as an example because that’s Penn Medicine’s home base,” says Paul J. Mather, MD, a professor of clinical medicine in the Heart Failure-Transplant program at Penn Medicine. From his 11th-floor office, Dr. Mather frequently looks out across the Schuylkill River towards Southwest Philadelphia. “The disparity in access to health care, health recognition, treatment, and outcomes is very high in this community in a negative way.”
Here’s one example: on average, the number of Black Americans who currently have heart failure is 1.5 times greater than the number of white Americans diagnosed with it, according to Dr. Mather. And new cases are being diagnosed at almost twice the rate – but earlier in life.
“Due to these social determinants, when they get to us they may present later in their disease course even though they may be younger than their non-African American cohorts.” Dr. Mather explains.
Disparities in Heart Disease Risk Factors
Many of the risk factors for heart disease, including high blood pressure, obesity and diabetes, occur at much higher rates among Black people.
The rate of high blood pressure (hypertension) among Black Americans is the highest in the world, according to the American Heart Association. It also develops earlier in life.
Obesity is most widespread among Black Americans (49.6%) and Hispanic Americans (44.8%), compared to other groups. The same is true for Type 2 diabetes.
And although Black Americans usually smoke fewer cigarettes than white Americans and start smoking at an older age, they’re more likely to die from smoking-related diseases than white Americans, according to the Centers for Disease Control and Prevention.
Because these factors are often considered preventable, the common misconception is that Black Americans simply need to be more mindful of their heart health. But that ignores the social determinants of heart health.
These days, there’s a growing awareness that improving heart health among all Americans will require taking into account social, economic, and environmental factors.
A Responsibility to the Community
Lowering the barriers to heart care is a personal mission for Dr. Mather. In 2018 Dr. Mather, in partnership with the American Heart Association’s Philadelphia affiliate office, took a group of doctors, nurses, and volunteers to seven public housing properties in North, South, and West Philadelphia over the course of a year.
“We checked people’s blood pressure, we taught them about nutrition, we brought a chef, we brought an exercise expert, and we tried to engage them,” he says.
Many people stayed away from Dr. Mather and his group. He estimates that on average, 30 people at each location took advantage of offered services. So last year, they recalibrated and took the group to the Victory Christian Center in West Philadelphia one Sunday a month for a year.
Meeting at the church seemed to boost trust among the predominantly Black congregation. Dr. Mather and his group offered blood-pressure checks and nutrition counseling to anyone who was interested. They also staged a farmers’ market. This time, they reached 1,280 people. “That was a profound impact.” Dr. Mather says.
Dr. Mather’s efforts to serve the community come from a sense of personal responsibility. Throughout his 26-year career as an academic, he’s always worked at a university in an underserved, urban environment.
Personal responsibility is where the pandemic and this latest social justice movement intersect. The path to health equity in America, Dr. Mather believes, begins with mutual respect.
“We all have an obligation to each other. I wear a mask to protect you. I hope you’ll wear a mask to protect me. I want to support your wellbeing so that your life is happier and your community benefits from your presence. And I hope you’ll want the same for me,” he says.
“We’ve spent so much time talking about the high cost of health care, as though that’s what’s kept these barriers in place. Prevention is a lot less expensive than treatment, so let’s try engaging everyone in a meaningful conversation about that instead.”
Caring for Our Community
Penn Medicine is committed to providing compassionate care for all patients in our community. As part of our commitment, we work to identify and respond to the needs of our neighborhood by partnering with community organizations and personal outreach projects of our employees.
Learn more about Penn Medicine’s commitment to serving our community.