As part of our Harm Reduction Series, this article addresses and explores a related topic: the social determinants of health. The U.S. Department of Health and Human Services (HHS) defines the SDOH as follows: “The social determinants of health are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
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And here’s our definition of harm reduction: “Harm reduction is a tactic that prioritizes minimizing adverse consequences from drug abuse as a first step before promoting abstinence. It includes measures like education and spreading awareness, supervised consumption sites, naloxone distribution, and needle exchange programs, aiming to reduce overdose deaths, transmission of infections, and associated health issues while encouraging a non-judgmental approach to support individuals on their path to recovery.”
You can see how the SDOH and harm reduction are related. Both approach substance use disorder (SUD) treatment – a.k.a. addiction treatment – from a holistic perspective. Both consider the importance of external factors that impact both the development of and treatment for SUD.
Harm reduction practices can help us mitigate the damage caused to individuals, families, and communities by the ongoing opioid and overdose crisis in the U.S. Addressing the social determinants of health while pursuing harm reduction efforts is essential: the two ideas go hand in hand, and in tandem, can help expand our concept of holistic, integrated care further, into areas that have proven benefit for people in recovery, but are not yet part of mainstream SUD treatment.
Why the Social Determinants of Health Matter
This statement from the World Health Organization (WHO) summarizes the impact of the SDOH:
“Research shows that the social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH account for between 30-55% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.”
This statement also reaffirms the connection between harm reduction and SDOH. With regards to SUD treatment and recovery, it reminds us – or teaches some of us for the first time – factors aside from the substances themselves, abstinence, and the treatment process play a more significant role than most of us realize.
The Department of HHS indicate five primary domains related to the SDOH:
- Economic Stability
- Education Access and Quality
- Health Care Access and Quality
- Neighborhood and Built Environment
- Social and Community Context
The SDOH can have either a positive or negative impact on overall health and wellness. Consider the following:
- Positive Impact on Health and Wellness:
- Safe neighborhoods
- Access to affordable housing and transportation
- Access to education and employment opportunities
- Opportunity to engage in safe, healthy outdoor activities
- Access to social support programs
- Negative Impact on Health and Wellness:
- Violence in community
- Racism/discrimination in community
- Air and water pollution
- Reduced access to healthy food
- Reduced access to health care
Here’s another connection between harm reduction and the SDOH: when we address them, we reduce the amount of harm external, environmental factors might cause people in recovery from SUD. Now let’s look at how we can address and improve the SDOH, with information from an excellent publication from the Kaiser Family Foundation (KFF) called “Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity.”
Reducing Harm by Addressing the Social Determinants of Health
KFF defines the SDOH as “the conditions in which people are born, grow, live, work and age,” which is an excellent and concise way to think about them. In contrast to the HHS approach to the SDOH, the KFF report expands them to six domains, as opposed to the five identified by HHS. We’ll use the KFF categories to talk about how we, as a collective working toward a common goal – reducing the harm caused by the opioid and overdose crisis – can help improve the lives of people in treatment for substance use disorder (SUD).
Improving economic stability means increasing opportunities to seek and gain employment. Having a job allows an individual to make a steady income to cover living expenses, medical bills, education, and recreation.
Neighborhood and Physical Environment
Improving neighborhoods and the physical environment means increasing access to safe housing, expanding public transportation, ensuring physical safety at all times, and expanding the amount of greenspace/recreational space present in each neighborhood, whether urban, suburban, exurban, or rural.
Improving education means starting early with pre-K and kindergarten programs for young kids, ensuring safe elementary, middle, and high schools for school age students, and expanding funding and access to literacy programs, language learning, higher education, and vocational training for adults.
Addressing issues around food and eating means reducing the amount of hunger and hungry people in our communities through expanding existing social support programs that provide resources for adults in the community and children at school, and reducing the phenomenon of food deserts by increasing access to healthy options in traditionally underserved neighborhoods.
Community and Social Context
Improving the community and social context in which people live their lives means increasing funding and access to social support systems and services, increasing community engagement and eliciting the involvement of community members and direct stakeholders, reducing discrimination in underserved neighborhoods, and addressing increasing levels of environmental, interpersonal, and social stress present in each neighborhood, area, or community – rural, urban, or other.
Improving health and health care – an area with which we’re familiar – means increasing insurance coverage for people who lack coverage, increasing the amount of providers in underserved areas, expanding and improving access to care, increasing cultural competency among providers, i.e. providing helpful language and cultural liaison services in health care, and finally, improving the overall quality of health care in traditionally underserved communities.
The Role of Communities in the Opioid Crisis and Harm Reduction
The social determinants of health are about improving the default living conditions in underserved communities across the country. When we say underserved, what we mean is communities which, for most of their history, have not experienced equity in domains like basic safety, education, health care, transportation, and access to affordable and healthy food. Deficits in these areas degrade quality of life, and improvements in these areas increase the quality of life.
It’s really that simple. Addressing the social determinants of health, by definition, reduces the chance of health-related harms in a community, including those related to the substance use that drives the opioid and overdose crisis.