What is Really a “Choice?”

By Stephanye R. Clarke


Where you live shapes not only how you live but how healthy you are. It is also, unfortunately, a fairly decent predictor of your life expectancy.

If you are in public health or a related field, you have likely heard of social determinants of health (SDOH).

I’ve had the opportunity to be in spaces where I hear statistics about different health outcomes by the zip code and census tract. I’ve also heard people at the table discuss how/why outcomes are different and what “those people” can do to live longer, healthier lives.

I frequently find myself wondering whether or not their world view would be the same if they were forced to trade places and circumstances with “those people” for even one month.

maze 5

These should be questions that make you say, “hmmmmm…”

Earlier today I came across an article that explored shopping at Ikea and likened the experience to a social determinant of health: built environment.  I’ve never been to Ikea—difficult to believe, I’m sure, but true. But, I can certainly relate to having the intent of going into a place of business to purchase just one item or an extremely short list, and walking out with a full cart, happy with my choices (until later when I’ve had a chance to settle in and review the long receipt).

Usually, these extra items weren’t carefully blended with the “normal” items—they were on end-racks and little displays throughout the store, all orchestrated to distract me and lure me into a glance, consideration and ultimately purchase.

Here’s where you might be thinking, “Steph, you have a choice!” You’re right, I do.

But what if I didn’t have a choice, though?

  • What if my high school diploma only afforded me the opportunity to work low-paying jobs?
  • What if my lack of resources, support and transportation suddenly limited my capacity to access a grocery store where I could purchase healthier foods?
  • What if, because of my income, I lived in an area deemed undesirable without sidewalks, lots of overgrown grass and marshes?
  • What if this area was surrounded by convenience stores, fast food establishments and liquor stores?
  • What if my local elected officials only ever visited my neighborhood when it was time for election/reelection?

It’s always important to take a step back and remember: I had a choice in the stores, right? Sure I did—and the layout of the store, with its tempting array of purchases suddenly becomes an irresistible tune to which I happily dance all the way to the cashier.

Unfortunately, for many residents in vulnerable communities, they had no say in the design of the layout of where they live, work or play. We need to carefully consider whether or not it’s actually a good thing to open another convenience or liquor store in an area asphyxiating from fumes of exhaust and despair.

At some point policy makers, community planners, providers, health educators and community members are going to need to have equal value at a collaborative table to figure out how every census tract in every city/town creates opportunities for its residents’ optimal health.

When that happens, we can expect increased life expectancies and healthier, stronger communities regardless of one’s street address.

Would they be able to navigate all of the systems with chronic underemployment, less resources, limited or no access to transportation and healthier food options? How difficult would it be to trade in what they have for decreased access to quality health care, green space, walkable streets and safe, affordable housing?

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