The Shared Determinants of Health and Wealth

Economic stability is a social determinant of health (SDOH), meaning it is one of the many conditions in which people are born, grow up, live and work that affect their health and quality of life. Specifically, poverty and financial insecurity can lead to poor mental and physical health outcomes.  But while the term “social determinants of health” implies a one-way directionality—different factors combine to influence health—we know that health itself interacts with and influences these factors as well.

When a family experiences a sudden emergency or unstable income, those who lack savings or assets can experience stress because of their financial insecurity. Long term financial stress can cause “toxic stress,” which can have lifelong negative effects on mental and physical health. The outcomes of toxic stress, such as depression, hypertension and heart disease, coupled with the outcomes of financial insecurity, such as loss of housing, accumulated debt and low credit ratings, can lead to devastating medical expenses and financial ruin for those unable to find financial stability. 

While the connections between health and financial well-being are well-documented, what’s discussed less frequently is how inequities in outcomes for both health and wealth share many of the same root causes. In other words, many of the social determinants of health also influence, and are influenced by, financial well-being. In this blog, we discuss a few of these common influences and how we can come together across fields to tackle them.

Shared Roots

Social determinants of health include factors like access to quality education, safe and stable housing, transportation, employment and economic stability. Just as the social determinants of health shape our understanding of what makes us healthy, our financial well-being is shaped by many factors outside of individual behaviors. For example, financial capability is determined not only by an individual’s knowledge, skills and access, but by the environment in which they live, work and learn. Below are just a few of the root causes shared by health and wealth outcomes:

• Racism and discrimination in healthcare delivery and financial services: The Racial Wealth Divide is caused by broad, widespread historic and present-day discrimination and structural racism. One aspect of this is the history of predation and underservice in the financial services sector, from limited access to safe, affordable financial services in communities of color to higher fees for services in these communities. Similarly, racism and discrimination in the healthcare field has led to a reality where people of color are “more likely to be uninsured, face barriers to accessing care, and have higher rates of certain conditions compared to Whites and those at higher incomes.” Historically, communities of color have been deemed a “risk” investment for healthcare insurance, have been denied quality health care providers and have greater geographic barriers to hospitals.
• Housing affordability and stability: Housing is a well-known social determinant of health that goes hand and hand with financial well-being and wealth. Stable, affordable housing is critical for building financial security, but discrimination in housing policies and institutions have had enormous deleterious impacts on the financial well-being of communities of color.
• Employment systems: Changes in employment systems over recent decades, including stagnating wages, minimum wages that don’t keep up with inflation or costs of living, the decline of unions and a shifting of benefits, has burdened employees and squeezed Americans even further financially. Employment impacts overall health as well, ranging from the mental health effects of insecure or substandard employment to the physical health effects of hazardous work conditions.

As with the health-wealth connection, the origin of these circumstances is multifaceted. Having little income or wealth, for example, can lead to unstable housing and less access to quality employment opportunities. Place also matters significantly since, to a large degree, where we live—as well as structural and institutional discrimination—shapes our access to quality education, safe and affordable housing, healthy food, employment opportunities and accessible financial services. These opportunities, in turn, shape the choices we make and establish the scope of possible health, wealth and other outcomes we experience.

Moving Forward Together

So, knowing the cyclical relationship of health, wealth and their common determinants, what can we do to address these very complex problems? How do we improve individual financial and physical health while also improving community health overall? Although we don’t have the answers to these difficult questions just yet, we’re confident that we can find them by collaborating across sectors, breaking down siloes and learning from each other. Moreover, solutions to these cross-cutting problems must come from the communities impacted, and their voices must be at the forefront of change. Through the Health and Wealth Network, we will create a space that centers communities and brings in stakeholders from across these interconnected fields. We hope you’ll join us in working toward change!