They refer to it as upstream. It’s where it all starts. That is, those things that influence how well we’ll be able to weather life.
Social determinants of health is another, related term.
But whatever the language, it all boils down to the fact that circumstances and conditions in our individual lives significantly affect our chances for staying healthy through the decades.
I grew up in a blue-collar neighborhood in Springfield, Massachusetts. Many of my friends and their families lived very close to the edge of hardship. Even as a kid, I saw how the circumstances of people’s lives could largely affect how well they’d fair physically, mentally and emotionally. The concept that serious adversity could set someone’s life on a troubled, health-depleting trajectory wasn’t so foreign.
I remember reading an article as a teen from one of my parent’s social work journals. It has stuck with me my entire life. The article asked the question: “What separates a child raised in poverty and adverse conditions who goes on to thrive later in life from those who don’t.”
I asked both my parents, who met while getting their master’s degrees in social work and spent their entire careers working with people in poverty and children in danger. What made the difference? Neither the article nor my parents had the answer, but the question has always stayed with me. What are those factors that enable some to rise above such difficult circumstances?
More and more, physicians, medical centers, insurance companies and others within the U.S. health care delivery system are realizing that what happens in the doctor’s office or hospital cannot compensate for all the other factors that significantly affect a person’s health and well-being.
Many healthcare providers and payers, in fact, are taking action, partnering with community organizations and implementing programs to address the social determinants of health within the ZIP codes where they do business.
Expressively stated in Healthy People 2020: “Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food and air; and the nature of our social interactions and relationships. The conditions in which we live explain in part why some Americans are healthier than others and why Americans more generally are not as healthy as they could be.”
When we think of the most complex social issues that our nation and Americans face today — homelessness, poor mental health, addiction, underperforming schools — physical activity doesn’t tend to appear on the short list of remedies that policy and decisionmakers draw up. Yet, I’m certain that it should.
I’ve long been a staunch believer that access to and engagement in exercise is a heavy hitter in an individual’s chances for a better quality of life. Certainly, the line connecting physical activity to better health is solid. Exercising regularly reduces one’s chances of developing cardiovascular disease, type 2 diabetes, depression, certain cancers, dementia and more.
But it also can serve as a powerful resource in addressing some of the broader social and societal issues that too often undermine health.
Jai Nanda believed so strongly in the connection between body, mind and a kid’s ability to succeed academically that he took a chance — a big chance. He maintained that if you engage youth in physical activity within a supportive team structure with positive coaching, it would provide the lynchpin needed to re-engage teens who had fallen off track academically.
So, in 2012, with minimal funding, Nanda opened a New York City charter school for high school students who were most at risk of not making it to high school graduation — Urban Dove Team Charter School, in the Bedford-Stuyvesant neighborhood of Brooklyn.
The unconventional education model includes roughly two to three hours of physical activity each day, including a varied mix of varsity sports, weight and cardio training, yoga, health education, plus group counseling.
Every kid who comes to Urban Dove is placed on a small, single-gender team headed by a dedicated coach who spends the entire day with that squad of students, advocating for them. That means on the playing field, in the classroom, and even at the lunch table.
The supportive, collaborative team environment, Nanda says, fosters both life and academic skills while bolstering health and wellness. Importantly, it draws these under-credited students into a place of belonging and community, giving them the desire to engage in a constructive school environment where they start to believe in themselves and what they can accomplish. Ultimately, what they’re really working toward is a brighter, more promising future for themselves.
Organizations and those who care for the homeless are acutely aware of the importance of opportunity for physical activity in children’s lives. The effect of adverse childhood experiences is of grave concern for this population. ACEsput many of these kids at significant risk for health issues later in life — seven out of the 10 leading causes of death in the United States, in fact.
Yet, experts also assert that by instilling certain habits, healthy coping behaviors, and protective factors, we can help shield against some of the negative consequences of these early adverse experiences.
Research shows that exercise and physical fitness can serve as one pathway toward resilience, which is so important to these children. In fact, recent behavioral health research identified participating in sports as a significant protective factor that has been shown to help mitigate some of the damaging long-term effects of ACEs.
Dr. Regina Olasin, who serves as chief medical officer for Care for the Homeless in New York City, observes: “Positive childhood experiences, such as those generated by physical activity and peer team interaction, are essential for developing the type of resilience that can act as ‘social immunization‘ against many of the negative outcomes of adverse childhood experiences.
“There need to be creative and normative alternatives for children facing homelessness so they can build resilience — to reverse the toxic stress that many of them are up against and increase their chances for a healthier future.”
As co-director of the National Center for Excellence in Homeless Services and associate professor in the School of Social Welfare at SUNY Albany, Heather Larkin fully understands the importance of interventive resources: “While ACEs do increase the risk for negative health consequences, people also possess areas of strength that can be supported to help ameliorate those risks. In our work, we need to teach that exercise is an effective self-care practice that can help people develop healthy coping skills and enhance inner resilience.”
Undoubtedly, the most entrenched social challenges affecting the health of our nation are complex, and they require many highly sophisticated solutions. But I urge policymakers, funding sources, decisionmakers within our healthcare delivery system, and innovators working toward positive change to recognize physical activity as the social determinant of health that it truly is.
“Upstream” is where people live. It’s where they struggle or thrive. We cannot afford to overlook a resource as effective — and practical — as regular physical activity.
Exercise is powerful. It’s time we leverage it and use it well.