Social determinants of health (SDOH) and food insecurity

What are the Social Determinants of Health (SDOH)?

The World Health Organisation defines the SDOH as ‘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’.

These forces and systems include economics, social policies and norms, and politics. These differ between various population subgroups and lead to disparities in health outcomes.

Initially the World Health Organization identified 10 social determinants of health which today are often grouped into categories such as, economic stability, education, social and community context, health and healthcare, physical environment including neighbourhood and housing.

Any problem with any of these aspects of a person’s SDOH can impact their health and wellbeing and quality of life.

SDOH and nutritional status

SDOH contribute to wide health disparities and inequities. For example, people who don’t have access to supermarkets with healthy foods are less likely to have good nutrition. Poor diet raises their risk of developing diet-related chronic diseases such as heart disease, type 2 diabetes, obesity and certain types of cancers and can lower quality of life and life expectancy. Just promoting healthy choices won’t eliminate these health disparities. In this example, action needs to take place to improve the daily living conditions in people’s environments.

Within and between countries there are significant differences in health that are closely aligned with the level of social disadvantage. Daily living conditions, or the circumstances in which people live, significantly impact their chances of attaining and maintaining good health. These avoidable inequalities within and between different groups of people make them more vulnerable to poor health.

Researchers have repeatedly shown that individuals from lower socioeconomic groups are least likely to comply with dietary recommendations and have lower intake of ‘healthy food options’. There is realisation that there are limitations of interventions which simply target individuals at risk and that it may be more cost-effective to widen the focus to population level determinants such as economic, social, and environmental factors.

Food insecurity and quality of life

The United Nations Food and Agriculture Organisation (FAO) states that food security exists ‘when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life’.1

Without healthy, nutritious foods, food insecure individuals are more likely to suffer from dietary related chronic diseases (NCDs) such as obesity, heart disease, high blood pressure, type 2 diabetes, and certain types of cancers. Food insecurity is often associated with poorer health outcomes and higher costs to the healthcare system.

Access and affordability

Having continual access to healthy, safe, and affordable food is essential for an individual to achieve a healthy dietary pattern. Inability to access foods that support healthy dietary patterns is linked to negative health outcomes.

Affordability also influences access to foods that support healthy dietary patterns, with evidence suggesting that low-income groups tend to rely on cheaper and convenient discretionary food options.

For example, those living in rural areas may have limited access to healthy food options, which also cost more compared to metropolitan or city areas. Fresh fruits and vegetables and other healthier items are often more expensive at small or sole independent supermarkets than in larger chain supermarkets and grocery stores. Others may have healthy food options close by, but are also swamped by cheaper and more convenient discretionary choices. Strategies focused on achieving more equitable access to healthy food choices, need to consider the cost and affordability of healthy dietary patterns along with the food environment.

Poverty and inequality are underlying causes of food insecurity and malnutrition. Poverty negatively impacts on the nutrition quality of diets. Income inequality in particular increases the likelihood of food insecurity – especially for socially excluded and marginalized groups.

Many individuals and families report having to make choices due to limited financial resources. For example, choosing between food and:

• paying for utilities,
• transportation,
• education, or
• feeding others in the household

Similarly, they may need to stretch their budget by various means such as purchasing cheaper, unhealthy food.

The high cost of healthy diets and persistently high levels of poverty and income inequality continue to keep healthy diets out of reach for billions of people across the world. The lack of affordability of healthy diets is associated with higher levels of moderate or severe food insecurity.