SVMC Community Health Needs Assessment 2021 - Catalog - Page 40
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As SVMC seeks to address healthy behaviors, including the diets of individuals, the structural and
systemic factors that govern access to nutritious food will undoubtedly need to be considered. SVMC
has limited ability to create largescale structural change in the arenas of food pricing, etc. but will
continue to partner with other area organizations dedicated to creating broad changes that make it
easier for individuals to consume nutritious foods.
Disparities in food security identified by SVMC’s community health survey:
43% of American Indian, Alaska Native, Native Hawaiian, and other Pacific Islander respondents
indicated a struggle with access to food, as did 35% of Black or African American respondents.
5% of those with professional degrees reported a challenge with access to food, compared to 42% of
those without a high school degree.
In tandem with larger, systemic forces that can influence one’s food options, the consumption of a
healthy, balanced diet also entails behavioral choices. Information regarding diet and nutrition can be
found within the Health Behaviors section of this assessment.
Financial standing and poverty
As mentioned in the framework on page 23, research indicates that while the social determinants of
health can influence outcomes, financial and socioeconomic factors are “the causes of the causes.” As
wages and accumulated wealth and assets increase, so too does social status and health status. Termed
the “socioeconomic gradients” in health, this pattern holds true within different racial and ethnic
groups, as well as within countries outside of the United States.41
Employment
The link between unemployment and negative health is more robustly established than the link
between employment and positive health. Those who are employed do typically have better health
outcomes than those who are unemployed, but the source of the benefit could potentially be attributed
to the wages earned, or the health benefits offered through an employer. Indeed, research has
indicated that the quality and stability of work is a large determinant in the net positive impact the
position will have on the health of the individual—jobs that are unstable, poorly paid, or demeaning lead
to poor health outcomes. Additionally, a much stronger body of evidence points to the detrimental
impacts of unemployment on health, including depression, anxiety, cardiovascular risk factors, and
lower adherence to healthy behaviors. There is some debate, however, about the risk of the “healthy
41
Braveman P, Gottlieb L. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep.
2014;129(Suppl 2), 19-31. doi: 10.1177/00333549141291S206
Southwestern Vermont Medical Center
Community Health Needs Assessment 2021