Being Poor Makes You Sick or How the Social Determinants of Health Matter More than Ever


When a flower doesn’t bloom you fix the environment in which it grows, not the flower.            ~ Unknown

We’re all busy. We all care – at least I like to think so. Most of us are working on our passions (or working on our own health), including #DigitalHealth innovation, better patient outcomes, health record interoperability, virtual care, payment reform, e-patient advocacy, healthcare access, and many more. You know who you are!

Today’s chat is about what underlies all of that – the needs of those that are missing one or more needed parts of the puzzle that allows them to be “whole” when it comes to their health. This is all about leveling the playing field, creating equity, and understanding that so many begin and run their health (and healthcare) journey starting from a significant deficit.

What’s excellent about the extended #hcldr community and friends? You all have a lot to say on this subject right now – from personal and professional experience to your own passions that drive your interest and concern. I won’t lecture you on the #SDoH since many of you certainly have or could write the book!

Research abounds on #SDoH and we have many nuances to consider within each of the domains shown above in the graphic. When we think ‘health,’ that covers so much ground, yet I find this graphic from The Henry J. Kaiser Family Foundation to be particularly telling:


A 20% impact from social and environmental factors! That’s hardly a winning gamble, yet for many, this 20% is baked in and is their starting point. Imagine further how weakness in social and environmental factors must certainly negatively influence the 40% impact from individual behavior.

Our peers in psychology and sociology can certainly share their thoughts on how individual behavior is influenced by who you spend your time with and in what circumstances. These two factors together, 60%, feed off each other in an insidious way that creates a poor destiny for many of the people we want to help.

While I love the succinct nature of the graphic at the top of this blog, I love the more detailed list of fourteen social determinants of health from the Canadian Public Health Association:

  • Income and Income Distribution
  • Education
  • Unemployment and Job Security
  • Employment and Working Conditions
  • Early Childhood Development
  • Food Insecurity
  • Housing
  • Social Exclusion
  • Social Safety Network
  • Health Services
  • Aboriginal/Native American Status
  • Gender
  • Race
  • Disability

Do review this list and spend time thinking about each item and how what you do affects each one. You’ll see how your passions interact with several of these factors. That certainly will lead to ways to mitigate and improve the situation for those at risk.

This week on #hcldr, let’s talk about how “being poor makes you sick” and how the social determinants of health don’t need to be the reason many lives are made miserable at best and/or cut short at worst. That’s what makes a difference to us, healthcare, and our community.

Join the #hcldr community on Tuesday, November 1, 2016, 2016 at 8:30pm Eastern (for your local time click here) as we discuss the following topics:

  • T1: How can we mitigate the #SDoH factors impacting the population?
  • T2: What impacts do you see from the #SDoH? Family, community, patients?  
  • T3: What led to/created this situation of inequity for personal health and even longevity? Is it definable?
  • T4: Is the ‘baked in’ inequity too great to be overcome for impacted populations? Are we chasing a ghost?


“Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity,” Harry J. Heiman and Samantha Artiga, The Henry J. Kaiser Family Foundation, Nov 4, 2015.

-Accessed 10/31/16

“What are the Social Determinants of Health?” Canadian Public Health Association,

-Accessed 10/31/16

Main blog graphic adapted from,

-Accessed 10/31/16

“When a flower doesn’t bloom you fix the environment in which it grows, not the flower,” Quote, various sources, unknown.


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