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The Collective for Health Equity and Well-Being

Cooperative Extension’s Collective for Health Equity and Well-Being is a community of Extension personnel and their partners united by their shared commitment to advancing health equity and well-being. Members work together to support the implementation of Cooperative Extension’s National Framework for Health Equity and Well-Being (2021) to ensure that all people can be as healthy as they can be.

ELI5: The Social Determinants of Health


To answer your first question, ELI5 is text lingo for ‘explain like I’m five’ and, admittedly, ELI5 posts from various online sources are the only reason I know random things. Example 1: What color would DNA be to the naked eye if we could see it? Translucent, because it is too small to reflect or absorb light. Example 2: How do zip/compressed files work? The code of regular files look like this – AAAABBBBBCCC – and zip files look like this – 4A5B3C. See what I mean by random?

And now, the reason you’re here…ELI5: The Social Determinants of Health.

According to the World Health Organization (WHO), the social determinants of health (SDH) are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life”.

ELI5: The entire world around you – near and far, big and small – affects your ability to be healthy.

Next, I’m going to ask a series of questions in each of the stages of life mentioned by the WHO. I hope that these questions will help you 1) more clearly understand what a social determinant is, 2) recognize the positive and negative determinants in your own life, and 3) think about others’ determinants, especially those that are not as privileged as yourself. Before you read on, keep in mind that this is not an exhaustive list and the issues represented in the following questions only represent some of the SDH.

  • Did your mother have access to quality care, prenatal vitamins, birthing classes, and other resources? Did she live in a safe home during her pregnancy and have access to healthy foods? Was she positively and safely supported by her partner or someone else? Where were you born? Was there a hospital nearby? Was that hospital properly staffed with quality medical professionals and amply supplied? Did the hospital staff prioritize three White patients before they would even look at your Black mother even though she was in distress? Was the White doctor frazzled when your mother started bleeding out because he was sure your Muslim father was a terrorist?
  • Did you have access to a quality education that prepared you to graduate high school and go on to college? Did your parents read to you and were you able to communicate in a positive way with them? Or did you walk to school in constant fear of getting shot, raped, or robbed? Were you abused by someone (emotionally, physically, or sexually, for example)? Were you endlessly bullied when you smelled and your clothes were dirty because the water bill couldn’t be paid? Did the stress of living in poverty and raising siblings practically on your own adversely affect your brain development?
  • Do you work? Are you paid a living wage? Do you have transportation to get you to work on time every day? Do you have the proper clothes to wear? Is your workplace safe? Do you have childcare for your children while you’re away? Maybe so. But maybe you’re a woman making 85 cents on the dollar compared with men. Or maybe you’re a Hispanic male making 69% of the earnings of that of a White male. Or maybe your factory hasn’t met a safety standard in years and your co-worker lost his arm to a machine last week.
  • Do you have positive and supportive family, friends, and community? Are you able to participate in civic organizations and clubs, visit a local library, or walk and bike around town? Do you have broadband internet, healthy air, and clean water with fluoride? Do you have access to mental health care, birth control, preventative visits, eye exams, dental cleanings, and cancer screenings? Are those services available within a 30 minute drive? Can you get prescriptions filled and understand then follow the instructions given to you? If you said ‘yes’ to all of these, you are the minority (like me).
  • Do you have an entrance to your home without steps? Do you have access to quality and healthy meal delivery services, home health assistance, and transportation? Are you financially stable and able to pay your bills? Do you frequently fall, have asthma attacks, or visit the ER? Are you socially isolated and lonely? Have you been a victim of elder abuse, scams, or Medicare fraud? Are you able to live independently and age in place?

Deep breath. If you knew nothing about the SDH beforehand, you’re probably overwhelmed. And that’s okay. I’ve been reading about the SDH for years and am still overwhelmed. Let’s summarize:

ELI5: The more positive things in your life and environment, the healthier you can be.

That ELI5 sounds easy, right? Let’s tell everyone to swap their cheeseburger for a salad and we’ll be on our way to a health revolution! Well…no.

The reality is that no one can 100% control their health outcomes. And many individuals will never be able to check the boxes that bode well as social determinants because they, as an individual, simply cannot change them. It takes all of us – individually and systemically. Racism, poverty, social injustices, and accessibility are uncomfortable, complex, and wicked issues, but they’re not going anywhere. And it’s high time we embrace the uncomfortable, complex, and wicked.

ELI5: We can no longer ignore racism, poverty, social injustices, and accessibility. These are the major issues influencing our ability to be healthy and well, and nothing will change unless we all do.

Let’s start a conversation. What are your reactions to this blog? What strikes you? What is missing? Post your thoughts in the chat.

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Many years ago, I participated in a book study of A Framework for Understanding Poverty, by Dr. Ruby Payne. While her work has sometimes been criticized for being a framework using a white, middle-class lens of the issue, it garnered significant traction is raising awareness and providing for conversations about poverty across many sectors, professions, and communities.

Your ELI5 article stirs up many of the same opportunities. It is hard for an individual to look at things from another person's perspective and anything beyond the surface level. However, that is NOT an excuse for keeping the blinders on. As you mentioned, it's past the time of playing it safe. We have to have those difficult conversations and time to embrace the uncomfortable, complex, and wicked issues facing our communities and clients.

It also means being courageous in communities where we can push the envelope in presenting new ideas. And to recognize that our Extension work is a both / and rather than an either / or in terms of direct education and the public health approach of policy, systems, environments.

It makes me think about the health impact pyramid.

We can spend countless hours and immense effort trying to coax people to change behavior when we might be able to make a greater impact through a focus on changing the context in which people live, learn, work, and play.

Thanks for making this so simple to understand!

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