Building Healthy Communities Through the Social Determinants of Health

By Tara DavisAugust 22, 2023

Building Healthy Communities Through the Social Determinants of Health
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Building Healthy Communities Through the Social Determinants of Health
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To further improve our communities, reduce harmful behaviors and create positive environments, the Army Resilience Directorate and its programs realigned from G-1 to G-9 and consolidated with the G-9 Soldier and Family Readiness Directorate on July 1 to create the Directorate of Prevention, Resilience and Readiness.

Now G-9 programs such as Quality of Life, Financial Readiness, Family Support and Morale, Welfare and Recreation and G-1 programs such as SHARP, SP2, ASAP and R2 are working together to provide resources and education and to build our protective factors to prevent health and behavioral issues before they happen, rather than through intervention or postvention strategies. This consolidation is expanding the capabilities of these programs beyond the individual scope to one that spans military communities and organizations, resulting in fewer Soldiers who are at risk of engaging in risky behavior by positively influencing the social determinants of health.

You may be hearing the term “the social determinants of health, or SDOH” more frequently, whether that be at your job, on the news or featured in posters around your community. But what are the SDOH?

"SDOH are the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping conditions of daily life,” as defined by the Centers for Disease Control and Prevention. This includes systems such as economic policies, development agendas, social norms, social policies, racism, climate change and political topics—all the things that fall outside of medical health factors.

“I would explain SDOH as the quality of and accessibility to things that significantly impact a person’s life,” says Latoya Johnson, prevention evaluation specialist for the Integrated Prevention Division. “I would ask someone to think about their home, their neighborhood, their job, their family and friends, recreational activities, their school, their doctor, food options, their place of worship. Think about the quality of all those things and if there is room for improvement in any of these categories.”

We can group SDOH into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Improving the quality and access to programs that make our Army communities healthier is the crux of SDOH in developing prevention capabilities and revising Army programs.

Communities are the Army’s real first line of defense. Communities are where our Army Soldiers and Families live, learn and grow. When they have installations with safe environments (both physically and socially) that promote healthy lifestyles with access to programs that support their needs, it allows them to not only survive but thrive.

“Data shows that healthy communities are linked to better health outcomes and stronger economies. To this end, military readiness increases when our Soldiers, their Families, and our Civilians have access to more of these things,” says Johnson. “If we think about healthy communities from a military context, we should consider whether our Soldiers, their Families, and Civilian personnel have access to quality education, safe and healthy living conditions, adequate employment and wages, transportation, physical activity and nutrition.”

Researchers at Northeastern University used information first introduced in Broken Windows Theory which stated that disorder (e.g. graffiti, deterioration) in urban neighborhoods led to an increase in serious crimes. Although their research didn’t confirm this theory, it did give way to new findings. Researchers’ findings suggest that although neighborhood disorder might not impact the likelihood that residents will participate in serious crimes, it will impact their health. The study suggests that neighborhood disorder affects three main types of health outcomes in residents: mental health, substance misuse and overall health.

What does this mean for you? Let’s imagine the “windows” in our own lives. Imagine your current neighborhood. Do you have sidewalks and parks, access to a local supermarket with fresh fruit and veggie options, access to safe housing and public transportation? Does your neighborhood have a low crime rate with little or no graffiti or abandoned buildings? Is it located near a hospital with emergency rooms and a quality public school system for children? If you answered yes to all these questions, chances are you and your family would self-report good, or at least better health, than someone who answered no to all or some of the questions.

The study goes on to discuss the psychosocial model of disadvantage, which states that when we live in communities that are impacted by disorder or stressful contexts, we have poorer mental health—leading to an increase in substance misuse (specifically associated with deteriorating mental health) and self-reported health. Disorder increases the allostatic load (instances of chronic stress, distress and depression) which impacts communities and leads to poorer health outcomes for those who reside in high-stress environments.

That’s why the Army is using SDOH to fix our communities’ “broken windows” and improve Soldiers’ and Families’ lives. “By considering SDOH, Army programs are improving Service member quality of life—in turn, improving Total Army readiness,” says Johnson. “Implementing strategies at the outer levels of the social ecology are going to impact more people and can really change the culture and climate. For example, incorporating Soldier preferences on future barracks designs, implementing a holistic approach when updating or developing policies and evaluating prevention activities to ensure effectiveness and quality all play a part in setting Soldiers up for success.”

If you are a leader, DA Civilian, Soldier or Family member looking for more information on the realignment of the Army Resilience Directorate to G-9, use this fact sheet. For more information on DPRR programs and capabilities, visit https://www.