Using social determinants of health to visualize comparative “lived experience” in urban neighborhoods

Background:Health is influenced by physical and social environmental factors with significant neighborhood variability, particularly in urban areas. A pilot project was conducted to develop the Social Influences on Health Snapshot (SIHS) measure. SIHS utilizes geo-spatial techniques to demonstrate social contexts of neighborhoods using resident-defined, rather than administrative (e.g. census tracts), boundaries. The measure places neighborhood social determinants within the context of a broader geographic region, through the calculation of relative disparity ratios.

Methods:SIHS development included selection of evidence-based social determinant of health measures, identification of available localized measures, re-allocation of secondary social data to resident-defined boundaries for 23 sub-neighborhoods within two urban neighborhoods, and calculation of a neighborhood-level additive measure of disparity (SIHS), which compares neighborhood social risks relative to their parent county.

Results:SIHS includes education, income, employment, housing, social disorder, transportation, and community safety variables.  The social disparity ratios for the two neighborhoods were double that of the parent county, reflecting social conditions less favorable for health. The sub-neighborhoods showed greater variability, with some sub-neighborhoods reflecting lower social risks than the parent county.

Conclusion:  Similar to the concept of income inequality, health may be most impacted by social determinants of health in situations where relative geographic differences are greatest. Tools such as the SIHS are innovative ways to demonstrate neighborhood differences in the “lived experience” of social determinants of health, inform prioritization of community development activities, and provide residents with a picture of how their neighborhood compares to a broader context in which they live.