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Lakida Kennedy, a member of the motorcycle club, Ghostface Ryderz, and new owner of Iyisha’s T.L.C. Child Care Center, demonstrated to a group of wide-eyed children about the importance of washing their hands. She put a dollop of gel into the children’s hands and they rubbed quickly and waited in line to examine germs, unseen by the naked eye but clearly visible under the black light hung in the bathroom.
The small bathroom was filled with laughing and long, drawn out groans of what one child loudly described as “gross.”
“Now wash your hands, and sing happy birthday.” Kennedy said.
Despite the copious amounts of soap dispensed, there were several factors which could not be washed away despite the furious scrubbing. While they could take the steps to prevent the average cold, they could not wash away was the environment, culture and socioeconomic status they were born into.
“The complex, integrated and overlapping social structures and economic systems that are responsible for most health inequities,” is the Center for Disease Control’s definition of the social determinants of health. The determinants are shaped by the distribution of money, power and resources throughout local communities, the nation and the world.
“The implications of the concept are huge,” said Nancy Tkacs, associate professor and assistant Dean for diversity and cultural affairs at University of Pennsylvania’s School of Nursing. “Since it would be logical to say that broadly improving social equity in education, income, access to full employment with good benefits, living conditions and neighborhoods that reduce hazardous exposures [such as]chemical pollution, violence and maximize healthy exposures [like]safe areas to walk, grocery stores with fresh fruits and vegetables, all of these contribute to equalizing health and well-being.”
One Street Makes a Difference
Powelton Village is a unique neighborhood and historic community just north of the campuses of Drexel University and the University of Pennsylvania. The area contains citizens varying from young professionals to longtime residents. When examining data which explores the social determinants of health, the drastic differences from those living east of Lancaster Avenue and those living west of the street which divides the neighborhood are dramatically visible.
East of Lancaster avenue is a more diverse and stable community. In this half of Powelton Village, white residents make up the majority of those living in the area. These residents have much better educational rates than their counterparts with less than half the city average of those who have not completed high school, and over double the average of those possessing an undergraduate degree, according to City-Data.com.
Traveling west across the avenue, the neighborhood’s demographics substantially shift in multiple aspects. The racial composition changes from predominantly white to an African-American majority. In this section of Powelton, almost 35 percent of these residents have not finished high school, which is roughly 1.5 times higher than their East Powelton neighbors.
Ben Hardy is an Australian nursing student at University of Pennsylvania who completes weekly clinical hours within the area and intimately experiences the concepts of social determinants of health on a personal level.
“I think health is something that most people don’t have the means to check up on, insurance or oftentimes health issues people have originate from the community because of poor eating habits, poor lifestyles and I guess, in this area, poor socioeconomic status too,” Hardy said. “So, when you have people with chronic illnesses who don’t take their medications or see a primary care doctor, they worsen over time.”
The Philadelphia Department of Health composed a study of prevalent health issues affecting residents of the city and examined the conditions by race and ethnicity. According to its results, 72 percent of black residents are overweight or obese, 17.2 percent have had diabetes and 43.7 percent have had high blood pressure. Of the three categories, African-Americans had the unfortunate distinction of having the worst health when compared to their Caucasian and Hispanic counterparts.
By understanding the data relating to the racial composition of the Powelton community west of Lancaster Avenue, this study illustrates the same exact problems and issues Hardy faces when treating patients from Powelton and the surrounding West Philadelphia communities.
“It is not peoples’ intent to be unhealthy, there are so many aspects of their lives that create unhealthy environments,” Tkacs said.
These issues have been noticed by local organizations, universities and the city government. There has been a push to increase access to healthy foods such as fresh fruit and vegetables through community gardens and farmers markets. The University of Pennsylvania continues to advocate to the surrounding communities about healthier lifestyles and address the underlying social, cultural and economic factors which influence the health of the surrounding communities.