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The Bigger Picture


The conditions and circumstances of where we live, work, learn, play, and pray affect all aspects of our lives, which are known as the social determinants of health. As individuals, we are embedded within various contexts of family, community, policies, and systems. There are multiple aspects of our lives that impact our ability to achieve our full health potential. Families living in impoverished communities are faced with restricted options, a lack of safety, scarce resources, and limited opportunities. Unfortunately, the unhealed wounds of racial injustice prohibits the affluence of America to not be equitably distributed nor readily accessible to all. Buried underneath these conditions we must acknowledge the historic and ongoing oppression through social, political, and economic disenfranchisement, which contributes to these social determinants.

A recent study published from the Jackson Heart Study in the American Heart Association’s journal Circulation: Quality and Outcomes, further illustrates the need to create communities with the social determinants in mind: stable housing, jobs with a living wage, effective education, and access to opportunities. The study highlights that African-Americans with depressive symptoms are more likely to suffer from chronic diseases, exercise less, and have lower levels of income and education. Additionally, the study also found that major depressive symptoms such as perceived stress contribute to increased risk of stroke and coronary heart disease among African-Americans.

This illustrates that perceived stress and depressive symptoms can result in poor health outcomes. These stressors and contributors to depressive symptoms are in part a result of our environment. The chronic stress of job insecurity, homelessness, food insecurity, lack of safety, gun violence, and other circumstances many communities and families face is real. According to the World Health Organization report The Social Determinants of Health: The Solid Facts, “stressful circumstances, making people feel worried, anxious and unable to cope, are damaging to health and may lead to premature death.” The long term psychosocial stressors due to the conditions and circumstances that impact our lives play a significant role on our health.

Therefore, our advocacy efforts propel us to think about the bigger picture. Advocacy must take the social determinants of health into consideration. We must understand how healthy food financing, complete streets, water access, and food marketing intersects with housing, community re-investment, economic empowerment, and employment. Our efforts must expose the toxicity of communities that result in depressive symptoms, chronic disease and inactivity. Through policy and systems changes we can demand for the equitable distribution of social, economic, and political resources, opportunities, responsibilities, and their consequences, for everyone. We must think about the bigger picture.