The so-called social determinants of health (SDH) is an initiative by public health advocates to identify nonmedical factors that affect health status. A related field of study is racial disparities in health. In a nutshell, poor minorities supposedly suffer from a myriad of health problems related to lower income, less education, lower access to medical care, living in food deserts, enduring poverty, microaggressions, discrimination, living in lead and smog-tainted neighborhoods on the wrong side of the tracks, etc.
The idea of SDH is so engrained in modern medicine that Medicare rewards physicians for tracking patient characteristics that have nothing to do with health status. Dr. Stanley Goldfarb reports on a recent primary care physician visit:
Along with the usual prompts about my health, I encountered a series of questions related to my financial situation.
The form asked whether in the last 12 months I was unable to pay my mortgage or rent on time, and if I was “worried that my food would run out before I got the money to buy more.”
These questions weren’t an attempt to gauge whether I would pay my medical bill; they were part of a campaign driven by political activists out to justify socialist policies in the name of improving health care.
Dr. Goldfarb argues the primary problem with study of SDH is that it is mostly bogus, saying:
But it’s not true: The framework is based on critical logical and empirical fallacies.
It confuses correlation with causation, while systematically downplaying or ignoring biological, behavioral and genetic variables that often have far more to do with differences in patient health outcomes.
A professor at the University of North Texas has done some great work identifying genetic causes of racial disparities in health outcomes. For instance, black people whose ancestors were from Central Africa evolved to live in an environment where salt was scarce. Sodium is an important mineral for health, playing a role in physiological functions necessary for life. These include electrolyte balance, nerve function, muscle function, fluid retention, and digestion. Over time their bodies evolved to be hypersensitive to what little sale was found in nature. When their descendants eat a Western diet high in sodium, the result is a disproportionate level of hypertension and heart disease, not because they live in a food desert devoid of green grocers.
That does not mean there are no social determinants of health. More from Dr. Goldfarb:
Behavioral factors — diet, physical activity, tobacco use, alcohol consumption and so on — consistently explain much of the variance in chronic disease outcomes, dwarfing the effects of income or education.
The Framingham Heart Study and numerous cohort studies repeatedly find that modifiable behaviors dominate risk, even in impoverished populations.
People who choose not to smoke, who eat vegetables, and who exercise regularly have better cardiovascular outcomes than those who do none of those things.
Social conditions can make healthy behavior harder, but they don’t make it impossible — and they certainly don’t deposit plaque into arteries.
In other words, the social determinants of health are largely behavioral, with a genetic component. It has nothing to do with income, microaggression, your job, or the neighborhood you live in. At its core, the study of SDH is primarily a push for socialized medicine and income redistribution. One of the biggest indicators of good health is education, not neighborhood. SDH is used for such left-of-center initiatives as Medicaid expansion, Obamacare subsidies, universal living wages experiments and welfare expansion. The initiative to study and implement (inaccurate) findings from the social determinants of health have little to do with medical care, and a lot do with income redistribution. The biggest fallacy is that if only we gave poor people more money and medical care they would be healthier, but it is not necessarily true.
The entire article is worth reading in the New York Post: Why my doctor gave a shot of socialism with my annual exam