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Chapter 7 ■ Health Disparities and the Social Determinants of Health
poor child growth. Although most persons would not consider access to potable drinking water a problem in the United States, there are many communities where access to potable water is a problem. Two examples are Flint, Michigan, and rural Alaska, where this remains problematic. 25 Many communities in rural Alaska require a boat, airplane, or snowmobile to access. These commu- nities are less likely to have treated or well water piped to their homes. They are more likely to haul small amounts of water in and sewage out. Mosites and colleagues found that rural Alaskans without piped water tended to sup- plement their water intake using sugar-sweetened bever- ages, which can lead to obesity and other health-related concerns. 25 This relationship between lack of piped water and consumption of sugar-sweetened beverages reflects the importance of having an adequate built environment for the promotion of health. In Flint, Michigan, the state governor appointed an unelected emergency manager because of the city’s financial crisis. 26 As a strategy to re- duce expenses, the city’s water supply was switched to the Flint River in 2014. Over the next year, residents were instructed to boil their water several times, high levels of lead were detected in the water supply, and an outbreak of Legionnaire’s disease occurred. It was later determined that the water supply coming from the Flint River was not being treated as effectively as the prior water supply and led to leaching of lead from the city’s outdated wa- ter pipes. Although the water supply was returned to its original source, residents were still being encouraged in 2022 to filter their water because of the corrosive damage that had occurred to their pipes. Social Context and Community SDOH related to social context and community focus on the characteristics of the contexts in which people live, learn, work, and play in order to achieve health and well-being. 24 The social context describes the settings in which people engage with each other, including groups they choose to interact with and where they work. Also referred to as the social environment, it includes the cultural traditions and behaviors of the members of a group. Within a defined community (see Chapter 4 for definition) there exists a diversity of ethnic traditions in conjunction with shared community cultural traditions. The cohesiveness of a community, or lack thereof, can impact the health and safety of community members. Issues such as neighborhood safety, discrimination, or poverty can result in challenges for persons with fewer resources. Community support can help mitigate these issues. HP 2030 has a specific goal to increase social and community support.
Nutrition and access to healthy foods are examples of the relationship between social context and commu- nity. One of the HP 2030 objectives under the social and community support goal is to eliminate very low food security in children. Addressing this objective within a community would require building support for existing programs available to the community, such as the School Breakfast Program, a federally assisted meal program, as well as understanding the challenges facing families within the community. It also includes understanding other components of a community’s context that con- tribute to food insecurity , including the number of fam- ilies experiencing poverty, population growth, access to food outlets with healthy food choices, and rising food prices. 27-29 Helping individuals and families to maximize their access to healthy food is thus linked to the social context of the community in which they live. ■ CULTURAL CONTEXT Addressing food insecurity requires understanding the cultural context of food. Culture plays a central role in what people eat. 30 According to Park and colleagues, the cultural element of food “describes traditional and local food knowledge and food practices that interact with values, pleasures, taste, and memories. It includes both the personal and regional foci.” 31 Food culture should be incorporated into programs aimed at increasing healthy eating and addressing food insecurity. 31 Mingay, Hart, Yoong, and Hure proposed a concept of food culture that can be applied to pub- lic health practice that helps to identify a positive food culture and the negative elements that currently impact healthy eating in modern culture. They argue that understanding food culture is a key component to enabling “population-wide and sustained improve- ments to the way we eat, and how we think and feel about food.” 32 Economic Stability SDOH related to economic stability focus on the finan- cial resources people have. 24 These financial resources include income, cost of living, and SES, which impact a person’s health. The onset of COVID-19 led to economic stability globally. Soon after the pandemic onset in March 2020, millions of persons lost their jobs. 33 By October 2021, there were still approximately 20 million households re- porting the impact of economic instability: not having
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