We hear it over and over and probably say it to our patients: to be healthy, follow a proper diet, don’t smoke, and be active. And if diagnosed with an illness, adhere to the agreed-upon plan of care. Sounds simple—and when patients return time and again with the same issues, we often blame them (secretly, of course) for not taking care of themselves.

But for how many of our patients is what we’re asking them to do less a matter of personal choice than a function of the neighborhood in which they live and the limitations imposed by their socioeconomic circumstances?

Many people don’t live within walking distance of a grocery store that offers fresh vegetables and fruit. Or if they do, they may not be able to afford the more nutritious choices, which are often more expensive. Many urban areas lack playgrounds. Air pollution and substandard housing materials can cause asthma and heart disease. Being born into poverty can result in poor nutrition, contributing to poor health, as well as limited access to health care, education, and job opportunities.

Social determinants of health, before we called them that.

Nurse and social worker Lillian Wald understood this when she and colleague Mary Brewster established the Henry Street Settlement in New York City’s Lower East Side, where she […]