What Is a Social Determinant of Health?

Social determinants of health (SDOH), according to the United States Department of Health and Human Services, include "...the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks" (Healthy People 2030). Social determinants of health include non-medical conditions that influence health outcomes (Centers for Disease Control and Prevention, 2022). Social determinants of health have been categorized around various constructs, some of which include: economic stability (Braveman, 2011; Healthy People 2030), inequality (Marmot, 2005; Marmot, 1999), immigration (Castañeda, 2015), education access and quality (Healthy People 2030), environments (Healthy People 2030), racism (CDC, 2022), access to health care (Healthy People 2030), political systems (CDC, 2022), and social and community context (Healthy People 2030). 

Racism as a Social Determinant of Health

The reason why social determinants of health are important to the 4-H program is because these social (non-health) factors influence youth proximal and distal health outcomes (a.k.a. positive youth development). In her article, "Levels of Racism: A Theoretical Framework and a Gardener's Tale," Dr. Jones describes two flower boxes—one with rich fertile soil and a second box with poor rocky soil. The flowers planted in rich fertile soil flourished, but the flowers planted in the poor soil struggled. The point of this analogy is that people who develop in resource-depleted environments can face greater health challenges compared to people who develop in resource-full environments. In regards to 4-H, youth who develop in better environments (e.g. safe neighborhoods, access to health care, good schools, etc.) stand a greater chance of achieving optimal health outcomes compared to youth who develop in poorer environments (e.g. violent communities, food deserts, lack of reliable public transportation, etc.).

Developmental Contexts as Social Determinants of Health

In the 4-H Thrive Model of Positive Youth Development, Dr. Mary Arnold provides an illustration that describes the process by which youth grow. The illustration has a flower planted in soil. The soil represents the developmental contexts (e.g. 4-H club) that youth interact with in order to learn new life skills and build new relationships. Within this model, the developmental contexts (i.e. soil conditions) can be understand as a social determinant of health. Specifically, the model outlines four developmental context factors that can shape youth outcomes, which includes: sparks (youth finding a particular passion in life), belonging, program engagement, and healthy relationships.

Spark as a Health Outcome

Regarding sparks, if the youth has a passion to learn about horses, but there are no horses in their neighborhood, then their ability to learn about horses will be limited. Contrast this with a youth whose family owns a multi-generational farm with several horses and caregivers who can provide mentorship with horse husbandry and other essential animal science skills. The youth who live on acreage with horses will likely learn more about horses than the youth who lives in a neighborhood without horses. This example illustrates how developmental contexts can shape a youth's opportunity to pursue certain sparks, which can then influence their ability to develop a certain skill or increase their knowledge of a particular content area (e.g. horse husbandry).

Belonging and Relationships as Health Outcomes

For belonging and relationships, having an inclusive environment is paramount. In contexts where there is racism, discrimination, or oppression can have detrimental effects on a youth person's ability to form positive relationships where they feel a sense of belonging. As Dr. Jones articulates in her article, "Levels of Racism," there can be institutionalized, personally mediated, and internalized racism (Jones, 2000). Institutionalized racism describe conditions where there is differential access to quality education, stable housing, gainful employment, quality health care, etc. Personally mediated racism describes when we form assumptions about the abilities, motives, and intentions of others based on their race or ethnic identities. Discrimination describes when we perform differential actions towards others according to their race or ethnic identities. 

Relation of Program Engagement and Health Outcomes

Participating in the 4-H youth development program provides many important opportunities. There are many facilitators (i.e. factors that increase program engagement) that positively influence a child's ability to engage with the 4-H program, such as access to reliable transportation, financial resources to pay fees, and caregiver support. Research has shown that there are many outcomes for California 4-H alumna, including a sense of responsibility, developing leadership skills, and public speaking confidence (Marshall-Wheeler, 2023).

Relation of Social Determinants of Health and Cooperative Extension

While we see that social determinants of health relate to the 4-H positive youth development program, what about other extension programming in the community? Do social determinants relate to extensionists who work with climate change, forestry education, invasive species, horticulture, and other important community programs and services? To answer this question, one may ask several questions:

• Does the program or service directly or indirectly involve the well being of people?
• Do environmental conditions play an important role in achieving programmatic success?
• Can policy or regulation influence the program?
• Does access to resources (material and/or immaterial) matter to the program's clientele?

The answers to these questions can reveal the relationship between social determinants of health and cooperative extension programming and services. As such, I believe it is important for us to remember that our work as extensionists can be enhanced by a deeper understanding of social determinants of health and their relation to our clientele. As we seek to address social determinants of health, our collective work in cooperative extension will ultimately achieve greater impact.

References

Arnold, M. E., & Gagnon, R. J. (2020). Positive youth development theory in practice: An update on the 4-H Thriving Model. Journal of youth development (Online), 15(6), 1-23. https://doi.org/https://doi.org/10.5195/jyd.2020.954 

Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: coming of age. Annual review of public health, 32, 381-398. https://doi.org/https://doi.org/10.1146/annurev-publhealth-031210-101218 

Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J. (2015). Immigration as a social determinant of health. Annual review of public health, 36(1), 375-392. https://doi.org/https://doi.org/10.1146/annurev-publhealth-032013-182419 

Centers for Disease Control and Prevention. (2022). Social Determinants of Health at CDC. Centers for Disease Control and Prevention,. https://www.cdc.gov/about/sdoh/index.html

Healthy People 2020. (2023). Social Determinants of Health. https://health.gov/healthypeople/priority-areas/social-determinants-health

Jones, C. P. (2000). Levels of racism: a theoretic framework and a gardener's tale. American journal of public health, 90(8), 1212-1215. 

Marmot, M. (2005). Social determinants of health inequalities. Lancet(9464), 1099-1104. 

Marmot, M. (1999). Epidemiology of Socioeconomic Status and Health: Are Determinants Within Countries the Same as Between Countries? Annals of the New York Academy of Sciences, 896(1), 16-29. https://doi.org/https://doi.org/10.1111/j.1749-6632.1999.tb08102.x 

Marshall-Wheeler, N., Nayak, R., Iaccopucci, A., & Worker, S. (2023). Long-term outcomes of early adult 4-H alumni. Journal of Extension, 61(2). https://doi.org/https://doi.org/10.34068/joe.61.02.02 

Overview

Recently I [Matt] had a chance to interview 4-H youth member Amari who is also this year's 4-H club president for Chicago Park in Nevada County. The following are Amari's responses to my questions.

About Amari

[Matt] What is your current role in the 4-H program? Describe your involvement and any leadership responsibilities you have.

[Amari] I am the Chicago Park Club President and I am a club participant. My Presidential duties are to lead the club meeting through the agenda setting process prior to the actual meeting. I also inspire kids in the club to be attentive. My goal is to re-create the meetings so they follow a more parliamentary pro procedure as it was when I first joined.

About Amari's Spark

[Matt] What is your “spark”?

[Amari] My 4-H spark is (when I was younger) watching the [4-H] meetings. They were very organized and followed a strong structure. In addition, I like working with animals and learning about the personalities of and the care of [animals].

Amari's 4-H Accomplishments

[Matt] As a 4-H'er, what are some of your proudest accomplishments?

[Amari] It was when I received a most improved horsemanship award at achievement night and I did not even own a horse yet. I had no previous horse experience and so this was a proud moment for me. This year I received senior showmanship at Fair with the horse I was using.

Looking to the Future

[Matt] Where do you see yourself in the next three years?

[Amari] I would like to be actively involved in leadership and continue to challenge myself with showing animals.

Advice for 4-H Members

[Matt] What advice would you give other 4-H youth members?

[Amari] I would tell young members that the more you put into the [4-H] program, the more you get out. Do not give up until you reach your goal.

Impact of 4-H Volunteers on Amari's Life

[Matt] What impact have 4-H volunteers made in your life?

[Amari] I would say my biggest change or impact is the ability to speak in front of a group and the confidence I gained throughout the program. They [4-H volunteers] have motivated me to show up and do my best. They encouraged me to be active in 4-H and be excited about the program.

About the 4-H Program

To learn more about the 4-H program in Nevada County, please check out our website.

Overview

Recently I [Matt] had a chance to interview 4-H youth member Kamden who is also this year's 4-H club president for Placer Hills in Placer County. The following are Kamden's responses to my questions.

About Kamden

[Matt] What is your current role in the 4-H program? Describe your involvement and any leadership responsibilities you have.

[Kamden] I am currently the President of the Placer Hills 4-H club. My responsibilities include planning and running community meetings, setting and cleaning up before and after meetings, and simply educating younger 4-H'ers.

About Kamden's Spark

[Matt] What is your “spark”?

[Kamden] My spark is probably music and more specifically singing. I have always loved to sing since before I could even speak I would hum. I have been in many different choir programs throughout my life and am currently a part of the National Gold-winning Colfax Chamber Choir. Singing is a form of art and I love being able to share that beauty with the world.

Kamden's 4-H Accomplishments

[Matt] As a 4-H'er, what are some of your proudest accomplishments?

[Kamden] One of my proudest accomplishments is becoming president of my club. I have worked hard in 4-H for seven years and have been in a leadership position since I first joined. I am proud to now be leading the Placer Hills 4-H club.

Looking to the Future

[Matt] Where do you see yourself in the next three years?

[Kamden] In three years, I plan to be attending College at either UC Santa Cruz or San Francisco State, majoring in Library Science and Minoring in Phycology.

Advice for 4-H Members

[Matt] What advice would you give other 4-H youth members?

[Kamden] I think one of the most important things to remember is that you don't have to go all out. You don't have to win every showmanship competition or raise the best animal. Do whatever you feel comfortable with but also strive to leave your comfort zone from time to time. Try new things. 4-H has a ton to offer even if it's not from your 4-H club. Other clubs will have cool projects that you can join. Simply try your best even if it's less than someone else.

Impact of 4-H Volunteers on Kamden's Life

[Matt] What impact have 4-H volunteers made in your life?

[Kamden] In my first couple years of 4-H, I always appreciated the help from older 4-H members. Without them, I would not know all the things I know now and may not even have become president without those people to look up to.

About the 4-H Program

To learn more about the 4-H program in Placer County, please check out our website.

Overview

Recently I [Matt] had a chance to interview 4-H alumnus Sandi Fitzpatrick, who is also our University of California Cooperative Extension Master Gardener President for Placer County. The following are Sandi's responses to my questions.

About Sandi

[Matt] Describe your experience as a 4-H'er in regards to leadership development.

[Sandi] I value my 4-H experience as it provided me with leadership and communication skills that I still use today.  Demonstration days provided communication experience in group settings and probably led me to be a member of my university speech team. Serving as 4-H Club President at a young age formed techniques that I use today as the President of the UC Master Gardeners of Placer County.

Impact of 4-H Volunteers on Sandi's Life

[Matt] What impact did the 4-H adult volunteers have on your life?

[Sandi] I credit much of my 4-H success (All Star and National Winner) to an adult volunteer who stepped into help when my mother had to return to night shift nursing following a divorce. Mrs. D. drove me to meetings, supported my project work, reviewed my record book, and enabled me to be involved in activities such as the 4-H Lamb Barbecue. Mrs. D was a guiding influence.

Picture from a newspaper highlighting Sandi as a 4-H youth member.

How 4-H Prepared Sandi for Leadership

[Matt] Describe one major life transition in your life and how the skills you learned in 4-H helped you make this transition.

[Sandi] I was given an opportunity in 2004 to become the Executive Director of the California Commission on Aging. I had to learn the ways of state government and legislature, advocacy, and managing diverse groups of older adults. I could learn these new endeavors because of the foundation my 4-H club work, junior leadership, and event planning provided to me. When I would stand to speak at a conference, I am always reminded that my first speech was at a 4-H Demonstration Day.

Advice for 4-H Members

[Matt] What advice do you have for our current 4-H'ers?

[Sandi] The 4-H program offers a range of education and life skills activities. I would encourage current 4-H'ers to seek out and participate in a variety of projects and events. These may form your secondary education or career choices as well as provide hobby and interest areas for life.

About the 4-H Program

To learn more about the 4-H program in Placer County, please check out our website.