August 06, 2020

By Katherine Ponte, JD, MBA, CPRP

Social determinants of health are “conditions in the places where people live, learn, work, and play [that] affect a wide range of health risks and outcomes.” There are many, and they can affect both physical and mental health.    
A focus on social determinants of health can lead to better mental health outcomes, including preventing mental illness. We all have a role to play in addressing them, individually and as members of society, working with local, state and federal government, nonprofits and companies.
Here are several examples of social determinants of health and potential ways to address them.

Economic Circumstances

Economic circumstances can significantly affect health risks and outcomes. Poverty, and particularly neighborhoods with a concentration of poverty, pose elevated health risks, including mental health disparities.
Creating economically integrated neighborhoods

As of 2014, almost 14 million people lived in extremely poor neighborhoods. The worst impacted were Hispanic and African American communities. They were more than three and nearly five times more likely, respectively, to live in an extremely poor neighborhood than poor whites.
People living in high-poverty neighborhoods exhibit worse mental health outcomes compared to people in low-poverty ones. Children can experience significant mental health problems from living in these environments, as can people with serious mental illness. This determinant is connected to reduced job opportunities, increased criminal activity and reduced quality of education in schools, which can contribute to other mental health stressors.
There are several initiatives that may address these challenges. One strategy is the creation of economically integrated neighborhoods. This concept can be accomplished in many ways, including the relocation of residents to less impoverished neighborhoods.
Increasing access to affordable housing

Poor housing can result in worse mental health. Adverse conditions such as dampness, mold and cold indoor temperatures may be associated with anxiety and depression. Worse yet, lack of affordable housing may lead to homelessness, which can exacerbate mental health issues. About 45% of the homeless population have mental illness.
A range of suitable housing programs should be available for those with mental illness. Access to affordable housing is certainly a larger social and governmental issue with meaningful implications for mental health. It is therefore an important area for advocacy.

Physical Environment

Certain physical settings, notably city environments, may pose greater risks to mental health. For example, the stimulation of an urban setting combined with a lack of green spaces and areas for exercise and social interaction can lead to sensory overload.
Dedicating spaces in cities for nature, exercise and socializing

There are four key areas that can improve mental health in urban settings:

      1.  More green spaces
      2. Active spaces that encourage exercise
      3. Social spaces that promote interaction
      4. Safe spaces, free of crime and traffic

These environments can foster a sense of psychological security, which can positively affect mental health. Urban planning can play an important role in positively shaping social determinants of health. Therefore, these types of strategies must extend to impoverished communities where they are needed most.

Neighborhood Cohesiveness

A healthy community can be critical to good mental health. Community can provide a sense of belonging and a source of support, which both benefit mental health. Neighborhood cohesiveness is critical to fostering a positive community since it often determines a community’s ability to act collectively on a wide range of issues, including mental health.
Many strategies can enhance cohesiveness, but here are two example that support community living and opportunities for recreational activities.
Build community gardens

Community gardens are collaborative projects in shared urban spaces. Participants share in the maintenance and products of the garden. In addition to being a source of food, community gardens create opportunities for people to work together to improve communities. The social interaction can reduce loneliness and social isolation, which are detrimental to mental health, in addition to many other benefits.
Establish community centers

In many neighborhoods, community centers serve “as a space for social interaction and the development of social relationships.” Dedicated spaces for interaction, like community centers,  can contribute to social capital, a sense of belonging and a sense of community. As a result, a community center can help participants feel empowered.
A community center, especially in a neighborhood with more limited services, should ideally offer a wide range of social interaction opportunities. Community centers can engage and support participants by offering:

  • Age-appropriate activities for a wide range of age groups
  • Specific programs for marginalized communities, respecting cultural diversity
  • Whole health activities such as exercise and meditation
  • Outdoor space
  • Meeting places, like a coffee shop or eating area
  • Health awareness education
  • Assistance with government benefits and referral services
  • Collaboration with outside organizations and professionals to offer services and supports

Volunteers can be recruited from within the community to help run programs. This engagement of community members may help build feelings of ownership, self-worth and purpose, all of which are beneficial to mental health.

Healthy Food Options

What you eat can significantly affect mental health. A growing body of evidence suggests that unhealthy eating patterns can lead to an increased risk for mental health conditions like depression and anxiety. An unhealthy diet can also lead to the development of various physical ailments, notably heart disease, stroke and type 2 diabetes, which in turn can worsen mental illness. For example, “people with diabetes are 2 to 3 times more likely to have depression than people without diabetes.” The relationship between mental and physical health and the role diet can play are important considerations, as the life expectancy of adults living with serious mental illness is 25 years lower, on average, often due to chronic physical diseases.
Unfortunately, lower income communities are at a disadvantage in eating healthfully. Food deserts, which are neighborhoods or communities with limited access to affordable and nutritious food, are commonly found in urban, low-income areas. These communities are less likely to have nearby access to supermarkets or grocery stores with healthy food choices.
Bring healthy food options to underserved communities

There are a few ways to address this disparity. Nutrition and diet awareness in communities can help. More business-driven strategies include incentives for supermarkets to locate in underserved areas, incentives for bodegas and corner stores to offer more healthy choices and developing local farmers’ markets.
Social inequities, reflecting decades-long systemic discrimination, have left impoverished communities at heightened risk for mental illness. To recognize and address these social inequities is to address the social determinants of health that disadvantage the mental health of these communities.
A significant and important segment of our population has been waiting too long for the government, companies and all of us to provide the equity they deserve.
Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City. 

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