Social Determinants of Health: New Study Reveals Hardships Faced by Americans

Report provides a sobering look at human hardships. 

A new report from the Robert Wood Johnson Foundation, NPR, and Harvard T.H. Chan School of Public Health was released last week. The outcomes revealed have every industry stakeholder talking: populations, providers, practitioners, and their patients.

The report entitled, Life Experiences and Income Inequality in the United States, provides a detailed exploration of the hardships faced by Americans in affording basic human needs: food, clothing, housing, transportation, medications, and the items mandated for persons to achieve health and behavioral health wellness. I’ve long said that the traditional face of the social determinants has shifted, including higher-income populations not often associated with health equity challenges. The general study affirms this fact, covering 1995 adults ages 18 or older living in the United States. Surveyed adults were divided into four income categories:

  • Top 1 percent highest-income households (earning at least $500,000/year);
  • Higher-income households (earning $100,000–$499,999/year);
  • Middle-income households (earning $35,000–$99,999/year); and
  • Lower-income households (earning less than $35,000/year), and more aligned with the current poverty levels.

Key survey results included the following:

  • 7 in 10 Americans across all income categories believe having a higher income allows people to get better health care.
  • Medical bill debt burdens those with lower incomes.
    • 57 percent of low-income adults and 48percent of middle-income adults report severe challenges in their ability to pay medical bills, compared to 8 percent of adults in the top income tier.
  • Additionally, nearly 50 percent of the top 1 percent and moreover 50percent of lower-income adults say it’s unfair that people with higher incomes can get better health care.
    • A majority across all income groups say it should be a priority for the government to make health insurance available to everyone living in the United States.

The top social determinants in 2019 were housing, followed closely by food insecurity. The report provided concerning ongoing data on those areas:

  • Over 35 percent of lower-income adults and 22 percent of middle-income adults report serious problems finding an affordable place to live.
    • This number is compared to 4 percent of the highest income earners.
  • In addition, 24 percent of low-income adults and 19 percent of middle-income adults struggle with rent or housing payments, compared to top earners.
  • Specific to food insecurity: 30 percent of low-income adults and 13percent of middle-income adults face “serious problems” paying for food. This number compared to less than 1 percent of the highest earners.

Monitor Monday listeners were asked this about what the most frequently cited unaffordable items for their patient population are. Over 50 percent of Monitor Monday’s listeners this past Monday participated with the most interesting results.

Our listeners continue to have their finger on the pulse of patient need, especially those related to the social determinants of health (SdoH).

Programming Note: Listen to Ellen Fink-Samnick’s live reporting on the State of the Union of SDoH on Monitor Mondays, 10-10:30 a.m. EST.


Ellen Fink-Samnick, MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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