Determining the influence of community on health: A social determinants perspective

Social determinants of health have been recognized as tangible influences on individual health and health outcomes. The 2003 Community Tracking Study provides a nationally representative sample with data from 60 randomly selected U.S. communities. Secondary analysis (n=31595) was restricted to those 18-64 years old. Poverty, education, gender, race/ethnicity, access to care, and unmet needs were shown to be the greatest predictors of health. Those in poverty (<200% below the Census poverty level), with high school or less education, females, who didn't get medical care when needed, and Hispanics reported disproportionately poorer health than those whose income and education level were higher, obtained medical care as needed, and whites. Community level data is important when discussing health disparities, as communities have varied resources to which individuals have unequal access. Data were selected by site (n=60) and analyzed using the same variables plus income inequality (Gini coefficient). By site, those with high school or less education were significantly more likely (p<.01) to report poor or fair health than those with higher levels of education. Poverty was not always a predictor of health status. However, unmet needs or access to care were predictors of health status in most sites where poverty was also significant. Gender and race/ethnicity were only significant predictors of health status in a few sites. It appears that community levels of income inequality are distal factors of education and poverty thus affecting health outcomes.