A couple weeks ago, a study published in the American Journal of Public Health estimated the number of deaths attributable to social factors such as low education, poverty, and low social support. Numerous studies have shown that social conditions – such as where you live, average income in your area, racism or discrimination, etc. – can be linked to health outcomes such as disease and death. In public health, these are often referred to as “social determinants of health” (see above picture for reference). Attributing one’s death to a single “cause of death” is a deceptive concept – often, a number of factors combine and compound each other to have an adverse effect on one’s health. In addition, the line from cause to effect is not necessarily linear. Rather, health outcomes are more likely to be the result of build-up over time of experiences (directly related to one’s health or not) throughout one’s lifetime.
The study by researchers at the University of Michigan and Columbia’s Mailman School of Public Health was a meta-analysis that looked at studies conducted between 1980 and 2007 on the relationship between social factors and mortality. At the individual level, the social factors included were: education, poverty, and social support (i.e. having friends, a social network, etc). The area level social factors were poverty, income inequality, and racial segregation.
Based on aggregate data, the study concluded that there were 245,000 deaths attributable to low education, 176,000 to racial segregation, and 162,000 to low social support. The authors noted that these categories are not mutually exclusive and, in fact, are likely to be related to each other. Although there were many limitations to the study with regards to data availability and methodology, this type of research is crucial to raising the awareness of the social causes of disease, which are often overlooked in our medically-focused healthcare system.
I think the New York Times summed up the take-home point well, by saying:
“If you say that 193,000 deaths are due to heart attack, then heart attack matters. If you say 300,000 deaths are due to obesity, then obesity matters…Well, if 291,000 deaths are due to poverty and income inequality, then those things matter too.”
Picture: G Dahlgren and M Whitehead Policies and Strategies to Promote Social Equity in Health (Institute of Futures Studies Stockholm 1991)