Social Determinants of Health and Lung Health

29 April 2024
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There is the age-old question of nature vs. nurture when it comes to human behavior or health. While we may have no control over our genetics, it’s critical to examine the social determinants of health that can influence our long-term well-being. The lungs take one of the biggest hits from external factors as they constantly take in and filter everything we breathe. This can include environmental pollutants, smoke, viruses, and bacteria. Dr. Meilan K. Han notes in her book, Breathing Lessons, A Doctor’s Guide to Lung Health, that the lungs aren’t even fully developed until age 25, highlighting the importance of lung health during fetal development, childhood, and even early adolescence where factors like smoking and e-cigarettes can come into play. 

It’s critical to examine the social determinants of health that affect our population’s lungs and how we can help mitigate and treat damage. The social determinants of health are defined by the World Health Organization, 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.” The social determinants of health or SDOHs are broken down into five key buckets by the U.S. Department of Health and Human Services. 

Key Social Determinants of Health 

Economic Stability

Economic stability[1]  is a critical factor in the health journey and is interconnected with just about every other aspect of our lives. For example, a child who grows up in a household with employed parents is more likely to live in a safe neighborhood, have access to good healthcare, receive a strong education, and in turn, pursue their own higher education one day leading to employment and health insurance. 

However, for the 1 in 10 people who live in poverty in the United States, this seems like an almost impossible route. A 2016 study of New Jersey residents found that the risk of dying early from long-term exposure to particle pollution was higher in communities with lower home values and lower median income. It is more likely that these communities live in areas with higher levels of indoor [2] and outdoor pollution[3]  and may also work in jobs with exposure to dangerous substances.[4] 

Another recent study on asthma in the Annals of Allergy, Asthma, and Immunology found that low income is also linked to higher rates of asthma and associated hospitalizations. These communities are also disproportionately Black or Hispanic. Children living in lower-income households are particularly at risk of developing asthma (and more likely to be hospitalized) as they are likely to live in areas with greater air pollution and live in homes with more exposure to secondhand smoke, mold, and pests. Economic instability also increases the chances that the family does not have health insurance causing a lack of ongoing maintenance medications for asthma leading to more potential hospitalizations. Researchers also noted that long-term stress is likely a factor through T helper 2 immune responses and hypothalamic-pituitary-adrenocortical activation.

Neighborhood and Built Environment

Your neighborhood and built environment, like your home and school, can expose you to many factors that are harmful to your health including both indoor and outdoor air pollution, fumes in a work environment, lead paint, chronic stress from violence, and many more. 

Exposure to secondhand smoke in your daily environment is an enormous long-term health risk. The Centers for Disease Control and Prevention (CDC) warns the public that even brief exposure to secondhand smoke can cause long-term health problems, and according to The American Lung Association, secondhand smoke causes approximately 7,330 deaths from lung cancer and 33,950 deaths from heart disease annually. 

Secondhand smoke also presents disastrous consequences for pregnant women and young children[5] . Pregnant women exposed to secondhand smoke are more likely to have babies with a low birth rate which can lead to a multitude of problems. Newborns exposed to smoke are at greater risk of SIDS (sudden infant death syndrome). Physicians believe the chemicals in smoke, including nicotine, affect the brain’s mechanisms for breathing regulation in a young infant. Toddlers and even older children exposed to smoke are at greater risk of asthma, respiratory infections, ear infections, and slowed lung growth. The American Cancer Society has found that children exposed to secondhand smoke also have a greater risk of cancers like leukemia, lymphoma, and brain tumors. 

Social and Community Context

The American Lung Association made the interesting discovery that those who live in predominantly Black communities had a greater risk of premature death from air pollution exposure than predominantly white populations, even when controlling for economic status. They theorized that other factors like chronic stress due to lifelong discrimination may play a role in negatively impacting the immune system and one’s overall health. Many decades of segregation have also caused Black people to live in areas where there is greater exposure to air pollution. 

Education Access and Qualities

Studies indicate that adults who have received higher education live longer and overall healthier lives than less educated peers. Individuals who receive a good education are more likely to pursue healthcare services and understand their importance. They are also more likely to have higher-level careers that offer increased payment and opportunities for health insurance. More well-educated individuals are typically better able to follow complex medical instructions, keep up with medications, and navigate the complexities of the US healthcare system. This can be critical in the treatment of complex conditions like lung cancer with researchers finding that patients with higher levels of education were likely to be diagnosed with lung cancer early and have better survival rates. Understanding the importance of prevention is critical as lung screenings play a vital role in identifying potential issues before they progress into serious, often irreversible conditions. Early detection of lung cancer and other respiratory diseases can significantly improve treatment outcomes and enhance overall quality of life. 

Healthcare Access and Quality

How easy is it for an individual to receive excellent medical care? Do they have health insurance? Do they live near a center of excellence? Individuals without health insurance are far less likely to have routine screenings, see specialists, and keep up with treatment plans. Researchers discovered that a lack of health insurance and access to primary care physicians and pulmonologists put individuals at a higher risk of asthma hospitalizations

Even if an individual has good health insurance, they may still suffer if their lung conditions are complex and require extensive travel to other facilities to see a specialist or receive the best treatment. The percentage of adults in rural areas who have been diagnosed with COPD is nearly double the percentage in large metropolitan areas. It is common to see higher rates of COPD in more rural and industrial parts of the country due to higher smoking rates, increased pollution, and jobs in toxin-producing industries, like coal mining. 

The Veteran’s Health Administration found that lung cancer screening uptake was very low in rural communities. Many Veterans live in rural communities (and have a smoking history or an exposure history to dangerous fumes during their time of service) putting them at a higher risk of lung cancer. A series of detailed interviews with veterans found that geographic distance, a lack of transportation, and local provider knowledge gaps all contributed to a reluctance toward screenings. 

Getting Creative and Addressing Disparities

So, how can we address disparities across our healthcare ecosystem? There are a few key strategies including, 

Community Outreach and Education: Implementing targeted community outreach programs can help raise awareness about the importance of lung screenings. Providing educational resources in multiple languages and culturally sensitive materials can bridge the gap in understanding and encourage more individuals to seek preventive care.

Financial Assistance Programs: Establishing financial assistance programs or subsidies for individuals with limited financial means can ensure that cost is not a prohibitive factor in accessing lung screenings. Collaboration between healthcare providers, governmental agencies, and non-profit organizations can help create sustainable solutions.

Policy Advocacy: Advocating for policies that prioritize preventive care and address social determinants of health is essential. Policymakers can play a crucial role in creating an environment that supports equitable access to lung screenings for all individuals.

Together, communities, technology, and leading healthcare facilities can come together to bridge care gaps. Today’s Healthcare in the U.S. is shifting to non-hospital facilities such as Ambulatory Surgery Centers (ASCs) and office-based Based Labs (OBLs). Designed around patient comfort and convenience while also offering some of the same advanced technology found in hospitals, these facilities are also looking for new ways to serve their respective communities. For example, Precision IR, a Farmington Hills-based center specializing in diagnosing and treating a wide range of conditions with minimally invasive techniques, now offers 4DMedical’s unique analysis to aid in diagnosing lung ailments in local veterans experiencing challenges navigating the VA Healthcare System.

Veterans exposed to toxic substances and airborne hazards during service face serious challenges in both diagnosis and treatment. 4DMedical’s analytical software will enable clinicians to extract rich data on lung function from standard X-ray scans. The information allows for non-invasive diagnosis and tailored treatment options through advanced computational algorithms to generate objective, information-rich, lung function reports and color-coded images.

By dismantling barriers related to finances, geography, health literacy, and culture, we can strive towards a healthcare landscape where everyone has the opportunity to benefit from life-saving preventive measures. The path to health equity may be challenging, but it is essential for building a society where well-being knows no bounds.


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