Social determinants of health (SDOH) are the myriad non-medical factors that influence health outcomes. These include the environmental, social, and economic variables in which people are born, grow, work, live, and age, as well as the wider set of forces and systems shaping the conditions of daily life.
Research shows that these social determinants can be more important than healthcare or lifestyle choices in influencing health. For example, numerous studies suggest that SDOH account for between 30%–50% of health outcomes. In addition, estimates show that the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.5,6,7 Therefore, understanding and addressing SDOH appropriately is fundamental for improving health outcomes and can be a useful tool in Disability claims management, especially in mental health claims.
SDOH fall into five categories:
- Economic stability
- Education access and quality
- Healthcare access and quality
- Neighbourhood and built environment
- Social and community context
How does climate change impact mental health?
Climate change impacts all five categories of SDOH mentioned, through either: (i) the direct impact of extreme climate events; or (ii) the secondary impact of other environmental-related disease, or (iii) because of its impact on social and economic systems.
Direct impact of extreme weather events
Climate change is influencing severe weather events such as floods, droughts, hurricanes, and wildfires by causing longer droughts and higher temperatures in some regions and more intense deluges in others, say climate experts. Such extreme weather events are becoming not only more frequent but also more severe.
A study in The Lancet says that many more people will be exposed to extreme weather events over the next century than previously thought: “a potentially catastrophic risk to human health” that could undo 50 years of global health gains.8
People who experience these events undergo many stressors, including the loss of loved ones, witnessing physical and emotional trauma, and displacement from their homes, among others. The psychological impact of such events can be profound, leading to acute and chronic mental health problems. Individuals are more likely to feel vulnerable, helpless, and hopeless, and this can lead to increased levels of mental health problems such as anxiety, depression, and post-traumatic stress disorder.9,10
Extreme weather events have also been associated with increases in aggressive behaviour and domestic violence. Exposure to extreme heat may lead to increased use of alcohol to cope with stress, increases in hospital and emergency room admissions for people with mental health or psychiatric conditions, and an increase in suicide.11
For some, even reading about these events can lead to feelings of despair, hopelessness, and an increased perception of daily stress.12
The increasing severity and frequency of these severe weather events places further strain on mental health services, which in many countries are under-resourced and under-funded. At the same time, there is often a disruption or decrease in the availability of these services. People who live in areas that are most affected by climate change are often the most vulnerable, and they may not have access to the resources they need to cope with the mental health impacts of climate change.
First responders, emergency workers and others involved with responding to extreme weather-related disasters are also at increased risk for mental health consequences in both the short and the long term.13
Early intervention is key, and insurers can play a valuable role by making policyholders aware of any mental health and/or wellness services available through their benefits. By ensuring these are provided in an appropriate and timely manner insurers can add value by bridging the gap created by long waitlists and delays in public health systems.
Secondary impact of other health conditions
Climate change and the circumstances that exacerbate it create unhealthy environmental conditions, with the result that almost all areas of health are being impacted. Particularly affected are noncommunicable diseases, including ischaemic heart disease, chronic respiratory diseases, and cancers. Injuries, respiratory infections, and stroke follow closely.
For example, an increase in air pollution due to the burning of fossil fuels contributes to respiratory problems, heart disease, and stroke. More heat waves can mean longer allergy seasons and more respiratory disease, while more rain increases mould, fungi, and indoor air pollutants and pathogens. Studies have even shown that long-term exposure to air pollution is associated with a decline in cognitive function.14,15
There is a known relationship between our physical and mental health and these physical health problems can, in turn, lead to mental health problems such as anxiety and depression. Evidence shows that mental health disorders such as depression, anxiety, and post-traumatic stress disorder can develop after other medical conditions, including heart failure, stroke, and heart attack. These disorders can be brought on from factors including pain, fear of death or disability, and financial problems associated with the event.16
Poor working environments also pose a risk to mental health.17,18 Therefore, increased occupational hazards such as risk of heatstroke and long-term exposure to workplace pollution, may contribute to increased perception of stress at work, which is a known risk factor for burnout and a decline in mental health. Insurers, especially Health and Disability carriers and those offering employee benefits, have an opportunity to influence working environments through educating policyholders on health and safety, and making evident the value of investing in wellness programmes.
Impact on social and economic systems
Good social systems and economic security are known to foster resilience to mental health disorders. For example, good diet has a positive impact on overall health, including mental health. Conversely, poor diet and food insecurity increase the risk of mental health issues and even the development of psychiatric disorders. Changes in weather patterns can cause disruptions in agriculture, leading to food shortages and price increases. People who are food insecure are more likely to experience anxiety, depression, and other mental health problems.19,20,21
There is evidence to suggest that access to green spaces has a beneficial impact on physical and mental wellbeing through physical access and use. Climate change is causing a decline in the diversity of plant and animal species. Many people have a deep connection to nature and feel a sense of loss when they see the destruction of ecosystems and the loss of species. Therefore, in additional to reducing the availability of access to green spaces for physical exercise and relaxation, the destruction of the natural environment can lead to feelings of sadness, grief, hopelessness, and loss.22,23
Climate change can exacerbate social inequalities, which can lead to mental health problems such as stress, anxiety, and depression. For example, people who live in low-income areas may be more exposed to environmental hazards and less economically resilient to the events mentioned above, which can further exacerbate mental health problems. Insurers play a valuable role within social safety nets by protecting the financial stability of policyholders in a time of need.
The impact of climate change on mental health is complex and multifaceted. There are several potential mechanisms through which climate change can impact mental health and this impact is likely to be more severe for people who are already vulnerable to mental health problems, such as those with pre-existing mental health conditions, low-income populations, and marginalised communities.
By developing a holistic and comprehensive understanding of an individual’s health and wellbeing, and tailoring our products to meet these needs, insurers provide a valuable service to customers.