Blue Cross Blue Shield MN Foundation

Social Determinants of Health

The social determinants of health influence a full 40 percent of health outcomes.

When understanding the Foundation’s mission and commitment to health, it’s important to note that while we look to the five primary determinants of health as a guiding framework, we also recognize their inherent interconnectedness. We focus on specific areas each year where we believe we can have the greatest impact. Yet we know that there is interconnectedness among all the determinants and that while our grantmaking may fund specific initiatives around, for instance, quality early childhood education, the community benefit extends into other areas.


Community Safety

Violence affects health and quality of life in both the short and long terms for the people directly and indirectly affected. Violence and fear of violence can keep people indoors, away from social support, exercise and healthy foods. In order for individuals and families to thrive, they need to feel secure at home and in their community.

Our grantmaking supports nonprofits that work to improve community safety by creating safe and welcoming communities for all, changing systems to reduce violence, promote safety and provide support for victims of violence. Communities without crime and the fear associated with crime can lead to neighborhood connections and promote quality housing, businesses and economic growth.

The Facts
  • Children in unsafe environments can suffer post-traumatic stress disorder and exhibit more aggressive behavior, alcohol and tobacco use, and sexual risk-taking than peers in safer environments.i
  • The chronic stress associated with living in unsafe neighborhoods can accelerate aging and harm health. Unsafe neighborhoods can cause anxiety, depression, and stress, and they’re linked to higher rates of preterm births and low-birth-weight babies, even when income is accounted for.ii

Education

Improving access to quality early education sets the stage for lifelong health. Education can open the door to opportunities for economic advancement and has the power to inspire confidence, cultivate self-efficacy and nurture the possibility of change. We know individuals and families with more education live longer, healthier lives than people with less education.

Low-income children receive the greatest gains from quality early-childhood programs. Empowering children through high-quality early education gives them the tools for social and economic success, enabling them — and their children — to lead healthy lives for generations to come.

The Facts
  • Men and women with more education are likely to live longer and experience better health outcomes.iii
  • Children who participate in high-quality early childhood development (ECD) programs experience a range of immediate and long-term health gains — in addition to cognitive gains and better academic achievement.iv

Employment

Unemployment and worry over job security can be all consuming, causing stress about income and access to basic necessities, such as housing, food and transportation. Access to employment and job-specific skills training serves as an important buffer for negative health outcomes caused by stress. Similarly, policies supporting workplace health and safety are vital for ensuring community health.

The Facts
  • Unemployment may affect physical and mental health in several ways:
    • Lowered income and living standards. Reductions in income associated with unemployment can lead to deteriorating physical health because of changes in ability to afford nutritious food, healthy housing and appropriate medical care.v
    • Increased stress. Loss of employment is associated with changes in health (such as increased blood pressure) and can limit access to health-promoting aspects of work (such as physical and mental activity, use of skills, decision latitude, social contact and social status).vi

Family and Social Support

Research conducted by the Robert Wood Johnson Foundation determined that higher levels of perceived social connectedness are associated with lower blood pressure rates, better immune responses and lower levels of stress hormones, all of which help to prevent chronic disease.

Increased social capital can result in greater support, improved access to resources, and the opportunity to create change. When individuals give voice to issues and harness power, they can generate the actions and solutions necessary for individual and community transformation.

The Facts
  • People with greater social support, less isolation and greater interpersonal trust live longer and healthier lives than those who are socially isolated.vii
  • Individuals who lack adequate social support are particularly vulnerable to the effects of stress, which has been linked to cardiovascular disease and unhealthy behaviors that include overeating and smoking in adults, and obesity in children and adolescents.viii

Income

Income provides economic resources that shape decisions about housing, education, child care, food, medical care and more. Poverty is a well-documented risk factor for negative health outcomes. Wealth — the accumulation of savings and assets — helps cushion and protect us in times of economic distress.

The Facts
  • In every racial or ethnic group, health status improves as income increases. Socioeconomic disparities are related to differences in resources and opportunities that affect health for all racial or ethnic groups.ix
  • 38 percent of the excess mortality among black adults compared with white adults in the United States was related to differences in income.x

i Susan Egerter, Colleen Barclay, Rebecca Grossman-Kahn and Paula Braveman, “Violence, Social Disadvantage and Health,” Issue Brief 10 (Princeton: Robert Wood Johnson Foundation, 2011), 5.

ii Ibid.

iii Susan Egerter, Paula Braveman, Tabashir Sadegh-Nobari, Rebecca Grossman-Kahn and Mercedes Dekker, “Education Matters for Health,” Issue Brief 6 (Princeton: Robert Wood Johnson Foundation, Commission to Build a Healthier America, 2009), 2.

iv Paula Braveman, Tabashir Sadegh-Nobari, Susan Egerter, “Early Childhood Experiences: Laying the Foundation for Health Across a Lifetime,” Issue Brief 1 (Princeton: Robert Wood Johnson Foundation, 2011), 4–5.

v Susan Egerter, Mercedes Dekker, Jane An, Rebecca Grossman-Kahn and Paula Braveman, “Work Matters for Health,” Issue Brief 4 (Princeton: Robert Wood Johnson Foundation, 2008), 9.

vi U. Janlert, “Unemployment and Blood Pressure in Swedish Building Labourers.” Journal of Internal Medicine, 231(3): 241–6, 1992.

vii “Family and Social Support,” County Health Rankings & Roadmaps, Robert Wood Johnson Foundation.

viii Susan Egerter, Paula Braveman, Colleen Barclay, “Stress and Health,” Issue Brief 3 (Princeton: Robert Wood Johnson Foundation, 2011).

ix Paula Braveman, Susan Egerter, Jane An and David Williams. “Race and Socioeconomic Factors Affect Opportunities for Better Health,” Issue Brief 5 (Princeton: Robert Wood Johnson Foundation, Commission to Build a Healthier America, 2009), 4.

x M. W. Otten Jr, S. M. Teutsch, D. F. Williamson and J. S. Marks, “The Effect of Known Risk Factors on the Excess Mortality of Black Adults in the United States.” Journal of American Medical Association, 263(6): 845–50, 1990.

PHOTOS (from top): St. Paul Youth Services; Minneapolis neighborhood; St. Paul Youth Services; Becker Market, Willmar; Northland Foundation; National Center for Healthy Housing