Dan O’Connor, PhD, is a member of the Core Faculty of the Johns Hopkins Berman Institute of Bioethics. He was for many years the Head of Research at RMM, a digital and social media strategy consultancy in London, UK. His research focuses on the ethical issues that arise from the use of social media to create and share health information.

Dan will be delivering the opening keynote at Embracing Innovation: Combining Science with Creativity to Improve Adolescent Health, Healthy Teen Network’s 34th Annual National Conference, this October in Savannah, GA. We recently caught up with him by phone to ask him a few questions about the social determinants of health.

For the benefit of those who are not familiar with the concept, how would you define the Social Determinants of Health?
Dan O’Connor: Basically, being poor makes you sick… I realize that’s perhaps a very trite way of putting what is a very complicated, serious framework…but I think it also gets right to the heart of the matter. There are certain things outside of biology and physiology, certain external factors, that have massive impacts on people’s health.

How do you address social determinants of health in your work?
DO: My work has primarily been in looking at social networks, online social networks particularly, and the ways in which people are able to leverage social media and internet technology—like Facebook, Twitter, online forums, that sort of thing—to exchange information with other people who have similar health conditions. One group I’ve looked at particularly and am hoping to publish [about] in the future are people with cancer who use Facebook and Twitter to reach out to other people in similar situations to not discuss necessarily the science or professional diagnosis, but the kind of every day lay experience of living with disease. And the marvelous thing about online social networks is that they allow people who previously might not have been able to talk to someone else in a similar situation, to reach out and form sort of a sense of community. Because one of the social determinants of health is connectiveness—being connected into a community, having a network available to you to discuss and talk about the experience of living with diseases. So my particular interest is in the way that social media and online social networks are sort of their own social determinant of health and the more access people have to these social networks and the more skilled they are at using them, potentially the better health outcomes people have.

Going back to your initial answer of “being poor makes you sick,” do you think that people’s financial situations and lack of access to the internet have an impact on their health outcomes?
DO: Yes, absolutely, but it’s not necessarily financial poverty—you might call it sort of a lack of social capital, which is about having the education and the access to the Web…and these are definitely social determinants of whether you are able to make the most of the opportunities afforded to you by social media for discussing and exchanging health information. So, there is a clear divide in terms of who is able to have reliable internet access—which is a poverty issue, a sort of economic social determinant—but there’s also the kind of educational and intellectual social determinants. Who has the social capacity to make the most of those opportunities? You know, if you’re very well educated, if you have a sort of base understanding of your disease, if you understand how social networks work, if you’re able to parse good health information from bad health information online, you have an advantage over people who perhaps lack that kind of level of social capital…. Being able to make the most of that access is, I think, a social determinant.

Why do you think it’s important for Healthy Teen Network, and fellow professionals and organizations in the field of adolescent sexual and reproductive health (ASRH), to address the social determinants of health?
DO: It’s not just you and your field—it’s everyone in the health field—if we don’t understand the social determinants of health, we’ll never achieve what we’re looking for, which is better public health outcomes, in total. If we constantly focus purely on biological and physical causes, we’ll constantly be merely treating people, rather than preventing. Improving the social determinants of health means that we get to prevent potential negative health outcomes.… I think that’s a positive way to go forward.

Addressing the social determinants of health is nothing new, but there seems to be an increased focus of late in the way people are talking about them and considering them in their work. Do you find this to be true?
DO: [For example] thinking about obesity [and] the obvious links that it has to poverty…. There’s an increased understanding that access to fresh foods and things like that is a clear social determinant of obesity, and that [understanding is] great and it’s very positive, but what I am slightly concerned about is that sometimes that focus shades into almost a blaming of the people who have got those poor social determinants. And I think that is something to be very careful that we ought to guard against…. [People who have] social determinants that are negative—or stacked against them—it’s not necessarily their fault. These things are socially embedded. So, while there has perhaps been some increased focus on social determinants, what that has to go along with is an understanding that people are not to blame for their social situations.

What ways do you recommend the field of ASRH incorporate social determinants into our work?
DO: I think I’m preaching to the choir, but one obvious key social determinant for adolescent sexual health is reliable information and being within a social environment—whether it’s a physical family and friends environment or an online social network—where you have access to reliable sexual health information…. And, speaking as a gay man, [I’d say] that one of the other social determinants of health is acceptance or a lack of stigma toward alternative sexuality. We know that there are a lot of mental health issues, particularly among LGBTQ teenagers and adolescents and that is primarily socially determined because of rejection and stigma, and that might be an area that could be a focus [for ASRH field].

Anything you’d like to add?
DO: I’m really pleased that Healthy Teen Network has got this focus on the social determinants of health because I think it’s something that gets slightly swept under the carpet, particularly in American public health…. Social inequality does lead to bad health outcomes—and they’re not just bad health outcomes for one person, they’re bad outcomes for the whole system.

How do you address or consider social determinants of health in your work? Do you agree that the role social determinants of health play sometimes gets “swept under the carpet?” If so, what can we do to change this? Leave your comments below!