social determinants of health : mackenzian

Correlation isn’t causation, but this is the most hope-building correlation I’ve seen this week.

Johns Hopkins researcher Julia Raifman, Ellen Moscoe, and S. Bryn Austin co-published a study of sixteen years of data from more than 26,000 lesbian, gay, and bisexual (LGB) high school students. A key finding?

In states that have legalized same-sex marriage, both heterosexual and LGB teens reported substantially fewer suicide attempts. By contrast, “in states that did not legalize same-sex marriage, there was no change” from previous years. Read the study yourself.

One of my favorite hashtags on Twitter is #SDoH, which stands for social determinants of health. It includes news and research from a sector of public health that acknowledges we can’t be healthy or whole in isolation.

Our health is literally shaped by social factors, factors that take shape well above the level of individual will. From the availability of nutritious food in our neighborhoods to the wider legal climate in which we live, learn, and love, we’re formed by social determinants.

Reifman and her co-researchers acknowledge the impact of social stigma on teens’ mental health: the literature shows that “the confluence of labeling, stereotyping, differentiation from the norm, status loss, and discrimination in the context of differential power” are associated with outcomes like depression, suicide ideation, and neurological disorders.

The important principle here: stigma (imposed) and shame (received) have physiological consequences, and improving the social environment improves individual outcomes.

As Dr. Mario Martinez writes, “In general, our biology adjusts to our cultural beliefs; and in particular, our immune system confirms the operative consciousness with which we choose to view our world.”

Martinez studies psychoneuroimmunology (he calls the field biocognition). He explains how our bodies interact with our experiences, how our emotional states aren’t merely “neurological”—brain-centric—but diffused throughout the systems of the body, and how social interactions like compassion and shame play out physically.

We look askance on industrial companies for their toxic waste dumps: how dare them foul the land and water that we depend on? But what consequences are there for those who dump stigma on marginalized and vulnerable people?

Zoomed in photo of a Black relay runner crouching and ready to launch off the starting blocks. They are in black fitted running shorts and Nike sneakers — Photo credit: Braden Collum

Thanks to NBC’s unimpressive approach to global sports journalism, Saturday’s news has revolved around the Rio Olympics swimming and track results.

Part of NBC’s narrative programming is marketing the belief that hard, individual work plus supportive nuclear social networks equals success. The formula appears in US advertising, such as Proctor and Gamble’s “Thank You, Mom” campaign and Minute Maid’s “doingood” video. It also appears in media analysis of much smaller competing nations, like Jamaica.

Today, the NYT posted a column from Harvard sociologist Orlando Patterson about factors that have contributed to the dominance of Jamaican sprinters over the last 50 years. The island produces far more winners and records than its population size and economic development might predict. Why?

Patterson cites government-led public health initiatives, which enhanced basic resources like food access, clean water, and anti-mosquito technologies, and therefore mitigated disease and improved life expectancy rates. He also outlines other factors like private investment in training programs, mentoring from previous generations’ athletics stars, coaching opportunities at well-resourced US universities, and Jamaican affirmation of hard work meeting raw talent.

Just as whole villages beyond nuclear families raise children, interacting influences beyond grit and determination shape our environments. All of these factors can enable us to become our best in each new context. All of them work together, and we progress in very different ways when those environmental factors change.

Every time you take a new job, you test this theory. If you thrived in your last position, and then move away, what are the odds that you’ll immediately thrive in your new location? Will you change how you interact with your colleagues, frame your contributions for others, describe your experience in applications, or choose training opportunities? Every change is an affirmation that environments vary and aren’t equivalent.

A major part of adjusting to each new environment is acclimating to new environmental elements that either enhance our development or undermine it. It’s not all solo-pluck: our environments can support us in becoming, and they can also sabotage our unfolding.

Sociologists talk about the social determinants of health as they invite us to realize that none of us lives in isolation from the world beyond our fingertips. Our environments shape our chance of surviving the journey from conception to birth and they also have substantial impacts on every aspect of our lives after we’re born.

Despite this, the narratives of solo-achievement persist, and only a few ever receive medals for standing at the right end of environmental interactions! Whether our growth is ever externally acknowledged, we grow in environments that enable us, and we can support others’ growth by building networks of policy and relationship that enable them as well.