As an individual who struggled with food allergies for a major part of my life, I chose to investigate the impact of social determinants of health on individuals with allergies and asthma.
In general, health disparities occur when there is a difference in health outcomes between populations. Healthy People 2020 has defined health disparities as “a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion”.
According to the Allergy & Asthma Network, social determinants of health (SDOH) is a broad term describing “conditions in the environments in which 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”. These factors include socioeconomic status, education, the neighborhoods and physical environments in which people live, employment opportunities, social support, and access to health care. These factors can impact the physical and mental health of individuals, as well as their ability to manage chronic conditions. Access to quality educational and employment opportunities, physically and environmentally safe neighborhoods, ability to afford and obtain food, access to culturally competent health care, and social support systems are all crucial to health. Without access to quality education, people may be less likely to obtain steady employment with a decent income and access to health insurance. This may contribute to affording safe (both physically and environmentally) housing and the ability to afford and access healthy foods. People may have to choose between food and housing over getting medical care and medications. Unfortunately, the emergence of COVID-19 has highlighted how social determinants of health are a major issue adversely affecting many populations.
When considering asthma and allergies, these are both conditions that require ongoing care and maintenance to maintain adequate control. Medication compliance is important to manage both asthma and allergies, but people may not use medications as directed or may ration them if they can’t afford the cost. This occurs with maintenance medications such as inhalers or rescue medications like quick-relief inhalers and epinephrine auto-injectors. Finances, as well as limited or no transportation may also cause patients to delay or forgo follow-up with their doctors. Some people may also live in an area where a lung doctor or allergist may not be readily available. Urban environments may have substandard housing with more exposure to asthma and allergy triggers such as mold, dust mites, mice, cockroaches, and pollution. Cultural and language barriers can also play a role in understanding health information, such as how to use an inhaler correctly. Even access to allergen-free food may be a barrier for patients due to cost or just lack of options for obtaining groceries.
Allergy & Asthma Network, Asthma Disparities and Health Inequities, accessed at allegyasthmanetwork.org. Davis CM, Apter AJ, Casillas A, Foggs MB, Louisias M, Morris EC, Nanda A, Nelson MR, Ogbogu PU, Walker-McGill CL, Wang J, Perry TT. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved. J Allergy Clin Immunol. 2021 May;147(5):1579-1593. doi: 10.1016/j.jaci.2021.02.034. Epub 2021 Mar 10. PMID: 33713767. Disparities. Disparities | Healthy People 2020. (n.d.). Retrieved May 17, 2022, from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities