It Feels Impossible to Be Healthy… Is It Just Me?
Many people come to us saying the same thing: "I feel like I’m failing at being healthy. I’m trying to eat better, move more, and manage stress, but life keeps getting in the way. What’s wrong with me?" Have you ever paused to consider all the factors that influence your overall well-being beyond just nutrition and movement? The truth is, health is shaped by a range of social and environmental conditions, known as the social determinants of health (SDOH). They’re called the Social Determinants of Health (SDOH), and understanding them can help replace blame with compassion.
What Are the Social Determinants of Health?
The SDOH are the social, economic, and environmental conditions that impact your health. They include:
✔ Where you live
✔ Your access to safe housing, healthcare, and food
✔ Economic stability
✔ Education
✔ Social support
✔ Exposure to discrimination or trauma
Studies show these factors account for up to 50% of your health outcomes, often more than individual choices around food or exercise.
The social determinants of health are a reminder that health is not just about personal choices. It’s deeply affected by systemic and structural conditions. Rather than focusing solely on weight, diet, or exercise, understanding the SDOH allows us to take a broader, more compassionate look at what supports real health.
Real-World Examples of the SDOH
Access to Quality Education
Higher education levels are linked to better job opportunities, health literacy, and access to care. Education influences decision-making around health-promoting behaviors and is directly tied to long-term health.
Economic Stability
When people struggle to meet basic needs like food, housing, and transportation, stress-related illness and chronic disease become more common. Financial insecurity impacts both physical and mental health outcomes.
Food Access
Food insecurity and food deserts reduce access to nourishing, affordable options. This leads to increased risk for nutrient deficiencies and long-term health issues like diabetes or hypertension. Food justice is a vital part of health equity.
Environment and Neighborhood Conditions
Air pollution, unsafe water, or a lack of green space can increase the risk of diseases. On the other hand, access to nature, walkable areas, and clean environments can boost mental health and encourage physical activity.
Social Support Networks
Strong social connections are linked to better cardiovascular health, lower stress, and improved longevity. Social isolation, by contrast, has been shown to increase the risk of mental health disorders and early death.
Access to Quality, Inclusive Healthcare
Barriers to healthcare, including cost, discrimination, or lack of culturally responsive care, can prevent early intervention and increase poor health outcomes, particularly among marginalized communities.
Discrimination & Systemic Oppression
Chronic stress from racism, sexism, ableism, and other forms of discrimination elevates stress hormone levels and inflammation, contributing to issues like hypertension, heart disease, and depression.
Trauma
Adverse childhood experiences and chronic trauma significantly influence physical and mental health. Trauma survivors may face heightened inflammation, disordered eating patterns, or risk-taking behaviors that impact long-term wellness.
What Diet Culture Gets Wrong
Diet culture often ignores the reality of systemic health barriers and sells a harmful lie: "If you’re not healthy, you’re doing something wrong." This narrative is not only entirely false but also harmful.
It promotes:
🚫 Moralizing food as “good” or “bad”
🚫 Unrealistic standards for body size or health
🚫 Blame for health struggles, ignoring systemic barriers
The reality is that factors contributing to our health extend beyond personal responsibility and encompass systemic issues that are often overlooked. The truth is that health is not a moral obligation, and more importantly, it’s not an even playing field.
How Intuitive Eating Fits In
Intuitive Eating (IE) is an evidence-based, weight-inclusive approach that encourages individuals to listen to internal cues and make peace with food. But here’s the nuance: Practicing intuitive eating is only accessible when your basic needs are met. Food insecurity, limited options, or economic stress make listening to your body harder. That’s not your fault.
Additionally, embracing intuitive eating requires a certain amount of mental space and effort, which may be in short supply for those struggling to meet their basic daily needs. Nutrition doesn't have to be your top priority if you're in survival mode. You deserve support that meets you where you are. That’s why working with a dietitian who understands food justice, health equity, and the SDOH can help you:
✔ Build habits that honor your current access
✔ Reduce food shame
✔ Focus on nourishment, not perfection
✔ Find care that meets you where you are
It's also important to note that while intuitive eating can be helpful for some individuals dealing with stressors related to SDOH, it is not a solution to these larger systemic issues. Advocating for policies that address SDOH, such as increasing access to healthy food options and affordable housing, is crucial for creating lasting change.
The SDOH is ultimately a list of reasons why we should not blame ourselves for being unable to conform to the narrow ideal of health promoted by diet culture. By examining the various factors contributing to our health, we gain a broader perspective and have room for meaningful choices that honor the social conditions in which we live.
For those who may be learning about SDOH for the first time, I hope that this knowledge can foster a greater sense of empathy and kindness toward oneself and others in matters of health while setting the scene for you to acknowledge your limitations AND strive to positively influence all the things you can to improve your health and well-being. The system is flawed, but you can still build well-being within your reality. You are not failing, you are navigating complex barriers. Reach out to the team at CV Wellbeing at any time for guidance and support. We promise to meet you where you are at.
Written by Alison Swiggard, MS, RDN, LD & Janet Steady, MS, RDN, LD, Registered Dietitian Nutritionists at CV Wellbeing
510 Main Street, Suite 103, Gorham, ME 04038
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They’re the social, economic, and environmental factors that shape your health. Things like where you live, your income, access to food, education, safety, and discrimination all play a role, often more than personal choices like diet or exercise.
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Your health isn’t only about what you eat or how much you move. Stress from financial struggles, limited access to nourishing food, unsafe environments, or discrimination can all increase your risk for chronic illness, mental health struggles, and make it harder to practice self-care.
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If you’ve ever thought, “I’m doing my best, but I still feel stuck,” the SDOH can help explain that. It’s not about lack of effort, it's often about real, systemic barriers that make health feel harder to access.
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It means your approach has to fit your reality. If access to food is limited, or stress is high, listening to your body and nourishing yourself might look different and that’s okay. You deserve support that meets you where you’re at, without judgment or unrealistic expectations.