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For the next few months, my intern, Elizabeth, will be taking over the blog bringing you supportive content related to Health At Every Size, Intuitive Eating, and the anti-diet, weight inclusive frameworks. Is there a certain topic you’re wanting to learn more about? Let us know by emailing leah@leahkernrd.com, we’d love to hear from you.

This week, Elizabeth is giving you the rundown on The Social Determinants of Health and how they relate to intuitive eating.

Take it away, Elizabeth!

The social determinants of health (SDOH) are a group of social conditions that make up almost 50% of the overall factors that contribute to your health. These are conditions that are often out of your control, and they tie into many overall inequities, racism, and elitism in diet culture. The SDOH are a true testament of how health is so much more than diet and exercise and why the perfect image of “health” that diet culture advertises is impossible for anyone to truly attain.

What are the social determinants of health and how do they impact a person’s health?

The five main social determinants of health are access to quality healthcare, access to quality education, social and community environment, economic stability, and a person’s home environment/ neighborhood that they live in (CDC).

Let’s take a look at each SDOH individually to unpack how these factors can impact health outcomes:

Access to quality healthcare can include physical access to healthcare (if there are hospitals or clinics near you and whether or not you have transportation to get there), whether healthcare is included in work benefits, financial barriers, and language barriers. It can also include a person’s healthcare literacy. A person who does not know how to navigate the healthcare system might not going to be able to receive adequate treatment for issues they may have. In addition, if someone receives a diagnosis that requires a specialty care team and the facilities they have access to are unable to provide that, they are going to miss out on that extra level of care and it may perpetuate their condition.

Access to quality education can affect health in a similar way to healthcare access because if you don’t have knowledge of how certain illnesses may look or feel, you might not know if you need to seek treatment. From quality education, a person also gains skills of critical thinking, knowing how to ask the right questions, and being able to advocate for oneself. These skills are something that we may not think impacts our health, but critically thinking and self-advocacy can ensure that a person is receiving the right treatments for them.

Social environments is the type of support system you have to help you work through some of the stressful times that might come up in your life. If you don’t have a good community to support you, you may not be able to mediate stressful events and this can negatively impact your health.

A great example illustrating the true impact of social and community context on health outcomes comes from a well-known epidemiological study called “the Roseto effect.” In this study, a community of Italian immigrants were curiously found to have very low incidences of heart disease despite having diets that were very high in foods that we normally associate with higher rates of heart disease. Researchers studied this community and found that this group of people was extremely close knit, having really strong cohesion and the community acted as a strong support system. It was determined that these close social relationships were what lead to these low rates of heart disease in the community (PBS). Many people would likely be surprised to learn that community context can actually have a greater impact on health than one’s diet. There have now been various other epidemiological studies with identical findings: social and community ties is an incredibly strong predictor for health outcomes. 

Economic stability is another factor that can greatly impact a person’s health outcomes. If you experience financial instability, you may not be able to even get enough food to fuel you throughout the day, let alone worry about making sure you’re getting enough variety and nutrients in your diet. Financial instability is often also a source of extreme stress because it impacts so many other factors of a person’s life. This chronic worry alone can lead to a chronic stress response in the body which in and of itself can be cause for negative health outcomes. Economic instability can also be a driving factor for all of the other SDOH. A lack of stable finances often translates to decreased quality of healthcare, decreased quality of education, and a decrease in stability of housing, because here in the U.S. these are all things that unfortunately arise primarily from a certain base stable income.

Neighborhood and Built Environment can affect a person’s physical access to resources as well as stress levels. Access to safe and adequate housing can include things like sanitation, sufficient space for everyone living there, neighborhood safety, stability of housing, and neighborhood infrastructure . If someone is living in poor sanitary or crowded conditions, they could be directly exposed to illnesses at a high rate. Housing can also severely affect a person’s stress levels if they are in an unstable housing situation, as they may not know if they are going to be living in the same place from month to month. Along with this, neighborhood safety can also severely impact stress. If someone works a late shift and has to walk home to an unsafe neighborhood, that is going to be a constant source of stress for them, and all of this stress can result in negative health outcomes which also can have negative impacts on health. Neighborhood infrastructure can also impact a person’s health outcomes because it may limit the health behaviors that they have access to.

One common example of how SDOH are often missed in a clinical setting is when a doctor recommends a patient spend more time walking outside. In this case, it is often not considered whether the patient even has access to sidewalks and if they do, whether the neighborhood is a safe place to be walking in the first place. 

What does diet culture say impacts health?

Diet culture often deliberately ignores the SDOH and instead places personal responsibility on people to improve everything related to their health (even if it is out of their control). Diet culture moralizes foods as good or bad, and in doing so ignores if a person even has access to the foods deemed as “good.” This is extremely harmful because if someone isn’t able to afford those foods, the food that they can afford is seen as “not good enough,” which can create feelings of shame.

In this moralization of food, diet culture also places great emphasis on avoiding common culturally rich foods and instead prioritizes foods commonly from white/ Caucasian cultures. This perpetuates issues of racism and classism in our culture, and shames people of different backgrounds for wanting to eat food that are comforting, meaningful, and culturally significant to them. Along with causing feelings of shame for a person, this can also cause isolation from one’s culture, which can in turn harm their community relationships and therefore cause more negative health outcomes.

Diet culture also demands a large amount of time and money to live up to the image of “health” that it portrays.

Most people don’t have the budget to buy all of their groceries at specialty health stores, attend boutique fitness classes, and  cook elaborate dishes for every meal, but diet culture says that this is the only way to achieve health.

This image is only attainable for a very small number of people with adequate time and financial means. Being unable to achieve diet culture’s definition of health creates even more feelings of fear, shame, and guilt… and when that select group of people who have obtained  diet culture’s picture of “health” advertises their success, you’ll often hear them saying something like, ” if I can do it, you can too!” While in reality, their “success” is often driven by factors largely out of one’s immediate control such as genetics, adequate resources, and financial stability.

Why considering the social determinants of health is important when thinking about nutrition

The SDOH are ultimately an entire list of reasons why it isn’t your fault for being unable to live up to the image of health that diet culture portrays! Looking at the other factors that contribute to our health can help us take a step back and analyze the bigger picture.

At the end of the day, it doesn’t matter how much kale or quinoa that you eat. If you are experiencing chronic stress in your life, and lack of access to adequate healthcare, no amount of “superfoods” will “cure” your health problems.

If this is the first time you are hearing about the social determinants of health, I hope that this can be something that can give you more grace and compassion when it comes to your health. There is a lot less personal responsibility playing into our health than we have been led to believe, and because diet culture has so much money, power, and influence, these other factors are rarely talked about since they go against the messages that diet culture is advertising. 

Did you hear the news? We launched a podcast here at Leah Kern Nutrition! Shoulders Down Podcast is a podcast designed to teach you how to harness your intuition to govern not just how you eat but also how you live. New episodes get released every Tuesday!  Click here to listen to our latest episode, “Self-Compassion and Making Space for Feeling Emotions with Lindsay Everhart.” 

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