Social determinants of health include where a person is born, resides, receives their education, and work. These factors can affect a person’s quality of life and health outcomes. I currently reside in Durham, North Carolina. With over 300 medical and health related companies, Durham is known as the “City of Medicine” (Welcome to the City of Durham | Durham, NC, 2023). Located in the piedmont region of North Carolina, Durham has a current population of 287,794 residents (Durham, North Carolina Population 2020 (Demographics, Maps, Graphs), 2023). However, of those 287,794 residents, 13.5% live in poverty; 5.47% more than the United States’ average. Of that 13.5%, Blacks and Hispanics make up the majority of impoverished ethnic groups. Durham was once the nation’s center for tobacco and textile production. However, as those jobs have disappeared and education and income requirements have risen, the original working class residents, who are often poor and Black, are being priced out of the city and forced to move to more rural areas (De & Hunt, 2018). This migration diminishes Black and Hispanic women and mothers’ access to higher wages, better education options, health care, and public transportation.
The population in Durham has increased significantly. So much so, that there is now a housing shortage. With limited supply and high demand, the cost of buying or renting a residence has significantly increased. According to Mobility Metrics for Durham, North Carolina (2021), for those living in poverty, there are few affordable housing options. They estimate that for every 100 low-income households there are only 34 affordable units available in Durham County. This shortage has forced some residents into homelessness, living in shelters, or staying in motels for extended periods of time. In 2020, there were 134 reported cases of domestic homicide. 77 victims were women and 99 offenders were male (Report on Domestic Violence Related Homicides for Calendar Year 2020, 2020).
The city is also challenged in improving the public transportation system for its patrons. In the documentary “Challenges To Equitable Transit – A Durham Documentary”, low income, Black, and Brown residents were interviewed about the transportation issues in Durham. According to the documentary, residents were seeking better sidewalks, safer transit connection locations, benches or shelters at bus stops, faster and more direct routes to healthcare facilities and colleges, and more reliable service (Law, 2021).
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The North Carolina budget signed into law on November 18, 2021 will gradually decrease the state’s corporate tax to 0% by 2030 (Skinner , 2023). This bill will make the state more attractive to corporations. However, it will not address the individual tax rate that is currently at 4.75% (Skinner , 2023). With more than 300 medical businesses in Durham possibly contributing zero tax dollars, middle and lower income residents will be required to pay more. I would propose changing this law and taxing corporations that choose to do business in the state. Those tax dollars could be used to install and fix sidewalks, provide more affordable housing options for low-income families, and improve public transportation.
De, A., & Hunt, H. (2018). Racial Inequality, Poverty and Gentrification in Durham, North Carolina. https://fpg.unc.edu/sites/fpg.unc.edu/files/resource-files/durham_final_web.pdf Durham, North Carolina Population 2020 (Demographics, Maps, Graphs). (2023). Worldpopulationreview.com. https://worldpopulationreview.com/us-cities/durham-nc-population
Links to an external site. Durham, North Carolina Population 2020 (Demographics, Maps, Graphs). (2023). Worldpopulationreview.com. https://worldpopulationreview.com/us-cities/durham-nc-population
Law, J. (2021, April 16). Challenges to Equitable Transit – A Durham Documentary. Www.youtube.com. https://www.youtube.com/watch?v=Fad5McQnDw8&t=3s Skinner , V. (2023, January 24). Analysis: North Carolina’s corporate tax rate lowest in the country. The Center Square. https://www.thecentersquare.com/north_carolina/article_22c487ce-9c2d-11ed-87a0-8f2cf dee8809.html
Mobility Metrics for Durham, North Carolina. (2021). Urban.org. https://upward-mobility.urban.org/sites/default/files/mobility-metrics-data-pages/999_cou nty-pages/37063/index.html
Report on Domestic Violence Related Homicides for Calendar Year 2020. (2020).
Skinner , V. (2023, January 24). Analysis: North Carolina’s corporate tax rate lowest in the country. The Center Square. https://www.thecentersquare.com/north_carolina/article_22c487ce-9c2d-11ed-87a0-8f2cfdee8809.html
Welcome to The City of Durham | Durham, NC. (2023). Www.durhamnc.gov. https://www.durhamnc.gov/1457/Welcome-to-The-City-of-Durham
Thank you, Needra, for sharing your insights on the social determinants of health in Durham, North Carolina. You have highlighted several important factors that contribute to health disparities in your community. I would like to provide additional insight and suggestions related to the issues you raised. Regarding Safe housing, transportation, and neighborhoods, the housing shortage in Durham, coupled with the rising costs, has led to limited affordable housing options, homelessness, and prolonged stays in shelters or motels. To address this issue, it is crucial to invest in affordable housing initiatives and increase the availability of subsidized housing for low-income families. Additionally, improving public transportation infrastructure, as advocated by residents in the documentary you mentioned, can enhance access to essential services and opportunities. In addition to addressing the housing shortage, it is important to consider the quality and safety of existing housing options. Ensuring that affordable housing is not only available but also meets health and safety standards is crucial (Crear-Perry et al., 2021). Furthermore, improving neighborhood infrastructure, such as sidewalks and street lighting, can enhance safety and promote physical activity. Collaborating with community organizations and residents to identify specific areas that require improvement can help prioritize and address these issues effectively.
You highlighted the racial disparities in poverty rates, which disproportionately affect the Black and Hispanic populations in Durham. Addressing systemic racism and discrimination is vital for promoting equitable health outcomes. Encouraging community dialogues, implementing anti-discrimination policies, and supporting organizations that focus on racial justice can help create a more inclusive and equal society (Cabral & Cuevas, 2020). To tackle racism and discrimination in Durham, community engagement and education are vital. Promoting diversity and inclusion in all aspects of society, including healthcare, education, and employment, can help create a more equitable environment. Implementing policies that address systemic racism, supporting implicit bias training for professionals, and fostering dialogue between different racial and ethnic groups can contribute to reducing disparities and promoting social cohesion.
The decline of traditional industries like tobacco and textiles, along with increasing education and income requirements, has resulted in economic challenges for the original working-class residents, particularly those who are poor and Black. To address this, it is important to invest in education and job training programs that provide accessible pathways to higher-paying jobs. Promoting equitable employment opportunities and supporting entrepreneurship can also contribute to reducing income disparities. In addition to job training programs, it is important to focus on educational opportunities for all residents, a process that includes providing access to quality early childhood education, addressing achievement gaps in schools, and ensuring that higher education is affordable and accessible (Cabral & Cuevas, 2020). Supporting initiatives that promote entrepreneurship and small business development can also create more job opportunities and increase economic mobility.
Access to healthy foods and opportunities for physical activity are crucial for maintaining good health. Strategies to improve food access include promoting community gardens, supporting farmers’ markets, and implementing policies that incentivize the establishment of grocery stores in underserved areas. Additionally, creating safe and accessible recreational spaces can encourage physical activity and improve overall well-being. In addressing food deserts and limited access to nutritious foods, considering strategies such as mobile markets, community-supported agriculture programs, and collaborations with local farmers can be effective (Crear-Perry et al., 2021). Additionally, creating safe recreational spaces in underserved areas, promoting physical education in schools, and partnering with community organizations to offer low-cost or free physical activity programs can help increase opportunities for regular exercise.
Polluted air and water can have detrimental effects on health as you have noted. Collaborative efforts between the government, industries, and communities are necessary to reduce pollution levels and improve environmental quality. Implementing stricter regulations on emissions, supporting renewable energy initiatives, and investing in clean water infrastructure are some measures that can be considered. Efforts to improve air and water quality should involve implementing and enforcing stricter environmental regulations. Collaborating with environmental agencies and community groups to monitor pollution levels and identify sources of contamination can help target interventions effectively (Crear-Perry et al., 2021). Supporting initiatives that promote renewable energy sources and sustainable practices can contribute to long-term environmental health.
Language and literacy skills are fundamental for individuals to access healthcare services, educational opportunities, and job prospects. Supporting literacy programs, providing language assistance services in healthcare settings, and promoting culturally sensitive education can help address language and literacy barriers and improve health outcomes. Addressing language and literacy barriers requires these comprehensive approaches for more complete resolution of persistent problems (Hill-Briggs et al., 2021). Providing language assistance services, such as interpreters and translated materials, in healthcare settings can improve access to care for non-English speakers. Investing in adult literacy programs and promoting early childhood literacy initiatives can help improve literacy rates and educational outcomes. Collaborating with community organizations and schools to provide language support and culturally relevant educational materials can also make a significant difference especially in a community such as Durham, North Carolina.
Crear-Perry, J., Correa-de-Araujo, R., Lewis Johnson, T., McLemore, M. R., Neilson, E., & Wallace, M. (2021). Social and structural determinants of health inequities in maternal health. Journal of Women’s Health, 30(2), 230-235. https://doi.org/10.1089/jwh.2020.8882
Hill-Briggs, F., Adler, N. E., Berkowitz, S. A., Chin, M. H., Gary-Webb, T. L., Navas-Acien, A., … & Haire-Joshu, D. (2021). Social determinants of health and diabetes: a scientific review. Diabetes care, 44(1), 258-279. https://doi.org/10.2337/dci20-0053
Cabral, J., & Cuevas, A. G. (2020). Health inequities among latinos/hispanics: documentation status as a determinant of health. Journal of racial and ethnic health disparities, 7, 874-879. https://link.springer.com/article/10.1007/s40615-020-00710-0