Health behaviors in a social context

Background: In 2010, economic insecurity reached a 25 year high with almost 1 in 5 Americans estimated as being “insecure”. Though all states experienced record levels of economic insecurity, states with higher proportions of minorities or those with a high school diploma were disproportionately affected. During this same time, United States crime rates were declining overall except for violent crime rates in areas more likely to be urban and have higher percentages of minorities and those with low education. Research on these intimately linked social phenomena tends to focus on the association with social disorder. However, less research explores how the social patterning of economic insecurity and crime by race and class in the US affects health behaviors and health. Methods: As such, we propose a multilevel, socio-contextual model for considering economic insecurity and crime as social determinants of health behaviors in urban minority communities. Results: With heightened media attention around violent crimes in urban communities and forecasts of slower economic recovery for minorities, we must consider economic insecurity and crime as structural barriers that impact the health behaviors and therefore health of minority communities. Discussion: Economic insecurity and crime in the United Sates affect the patterns of disease distribution through historical roots in race- and class-based policies. Elucidating this patterning will provide the opportunity for a systems based approach to policy and intervention development that address the context in which individuals makes choices as opposed to solely addressing individuals.