A first-ever Texas public opinion survey on social determinants of health (SDOH) has revealed that Texans largely agree on many issues regarding the significance of the impact of non-medical factors on human health. Recognizing the increasing awareness that social factors impact people’s well-being, the Episcopal Health Foundation (EHF) surveyed a representative sample of 1,200 adults age 18 and older living in the state of Texas to gauge public opinion on various issues around SDOH. Although there is broad agreement amongst Texans on a number of SDOH-related issues, notable demographic differences exist that should inform future policy considerations.
Survey results from EHF indicate that a majority of Texans (57%) believe having good medical care is not enough for a person to live a healthy life. Rather, most Texans see non-health related factors, namely social determinants of health, as playing a significant role in influencing health outcomes. When asked to identify problems facing residents today, a majority of Texans rated several social determinants as big to moderate problems.
Most widely identified as a big to moderate problem was the number of people who struggle financially (80%), followed closely by crime and public safety issues (74%), and income inequality (73%). Roughly 6 in 10 Texans also identified racial discrimination, poor quality K-12 public schools, and unemployment as big to moderate threats to Texans’ health. When then asked how important various social determinants are to health outcomes, a majority of Texans identified every listed item as essential or very important.
Survey questions related to SDOH-specific interventions further revealed that Texans largely agree on addressing these health factors. For example, a majority of Texans believe that addressing social determinants of health should be a priority of the Texas state legislator. When asked about ten different health priorities (all relating to SDOH) for the state legislature, at least three-quarters of adults viewed all issues as important, with 6 of 10 ranked as top priorities by at least half of Texans.
In line with these opinions, 66% of Texans believe that the health of Texas residents would improve if the state were to spend more money on addressing non-medical factors. However, only 49% of Texans said that the state legislature should use a portion of the money the state already spends on health care to address social determinants of health.
Despite this broad agreement, views at times diverge along various demographics, including race, immigration status, insurance coverage, and education. For example, 53% of Texans without a college education say good medical care is enough to live a healthy life, compared with 42% of those with some college education, and 25% of those with a degree. Similarly, although Texans largely agreed when rating the importance of various social determinants on health outcomes, divergence arose along race/ethnicity and income. In particular, Black or Hispanic residents and Texans with incomes below 250% FPL were more likely than their counterparts to consider education, housing, and income to be essential to people’s health.
Similar trends also carry over in respondents’ views on SDOH interventions. For example, there are notable demographic differences regarding what Texas residents believe should be the priorities of the state legislature. In regard to the issue of racial and ethnic discrimination, 56% of Black and Hispanic Texans believe this issue should be a top health priority compared with only 42% of whites. Texas residents also diverged on the issue of adequate paid individual and family sick leave from work with 54% of women saying that it should be a top health priority, compared with just 37% of men.
Such variance reflects uneven levels of understanding about the complex ways in which these issues impact health and may point to the need for further interventions that raise public awareness about and mitigate these unequal challenges.
As indicated by EHF’s president and CEO Elena Marks, understanding public opinion in these areas can be critical for advancing dialogue around SDOH.
“These numbers should spark important conversations across the state on how we can focus on the non-medical, underlying causes of poor health that have nothing to do with going to a doctor or hospital,” said Marks. “So many Texans face a range of social and economic conditions that almost conspire against their health. We have to change the conversation to improving health, not just health care.”
The EHF study offers a high and replicable standard for soliciting views on SDOH among residents in other states and communities.