Q: Can social factors affect your ability to maintain healthy blood iron levels?
A: Yes, they can. But there are ways to offset these factors by building personal and community awareness and advocating for social change.
Health-related social factors (also known as social determinants of health, often shortened to SDOH) are non-medical aspects of life that influence our health and well-being. It’s tempting to think of our health outcomes as the direct result of our individual behaviors, but the truth is that even these behaviors are shaped by the environments where we live, learn, work, play, worship, and age – as well as the other people who inhabit these environments with us.
Social Determinants of Health (SDOH) wheel [archived link]
Source: Healthy People 2030 Campaign, Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services
When it comes to chronic conditions like heart disease or stroke, the roles of different social determinants in shaping health outcomes have been heavily researched and may therefore be easier to identify (like access to transportation to attend regular checkups, living in a neighborhood with diverse food and recreation options, and economic stressors and responsibilities). However, when it comes to iron levels**, determining how our environments influence how well we absorb iron or our red blood cell count can be trickier to pinpoint.
While iron deficiency can occasionally be due to genetics or autoimmune conditions with unknown causes (like Celiac disease), most cases of iron deficiency can be explained by social factors – how we engage with the world, and how the world engages with us:
🎨 (The socially constructed idea of) race and its many offshoots: Black, Hispanic, and Asian people all have higher rates of anemia [archived link]– a condition whose most common cause is iron deficiency – than non-Hispanic White people in the U.S. In fact, Black people assigned female at birth are at least two times more likely than their Asian and Hispanic counterparts and nearly four times as likely than their White counterparts to suffer from iron deficiency. This is not because Black people are “biologically wired” to have less iron than anyone else (this belief went unchallenged for a very long time – more on scientific racism [archived link]. Rather, generations of racist food policies and practices have made the ability to purchase (and grow) nutrient-dense, iron-rich foods significantly more difficult [archived link] for people of color. And while food insecurity – and the resulting iron deficiency – have a deeply historical and well-researched relationship to race, they also generally impact low-income communities with less access to health insurance, land, employment, or other key economic resources.
➡️ A side note on race-based diagnostic criteria: Did you know that until recently, iron deficiency was measured differently in Black people than in others? For a long time, Black people were generally assumed to have lower levels of hemoglobin (the protein in our red blood cells that contains iron) than other people. This was deemed “natural”. As a result, the standard cut-off for diagnosing and treating anemia was often lower for Black patients. This can lead to Black patients’ iron deficiency being ignored until their hemoglobin levels become dangerously low. For some people, such as those about to give birth and those with medical conditions that might lead to blood loss – this could have fatal consequences. Fortunately, the American College of Obstetricians and Gynecologists has successfully pushed to remove the race-based adjustment [archived link] made to anemia screenings, but there is still plenty to be done when it comes to removing structural barriers to people of color accessing and receiving adequate, anti-racist care for iron deficiency.
🕰️ Aging: The likelihood of anemia tends to steadily increase with age, but it does not have to be this way! Like in other marginalized populations, many cases of iron deficiency in older adults are due to a lack of nutrients. According to Feeding America, nearly 7 million adults aged 65 and older were food insecure in 2022, and with a growing aging population, this number is predicted to increase to 9 million by 2050 [archived link]. With many older adults living on fixed incomes, affording nutritious meals may be more difficult. Even if older adults DO maintain balanced diets, the medications they might take for the variety of chronic conditions that often accompany older age may slow down their iron absorption. We are also more likely to become physically disabled as we grow older [archived link], and while physical disability itself does not cause anemia, it does mean that using personal or public transportation for essential needs such as grocery shopping or health check-ups becomes more complicated.
➡️ Here, it makes sense to mention the role of community connectedness and support in helping to maintain healthy iron levels. Having a neighbor or relative who is able to help with cooking or running errands when you do not have the time or ability on your own can help offset barriers posed by other social determinants. Social connectedness is not just a social determinant of mental health; it represents our ability to access others’ assets and resources when we need them most. In a world where so many of our interactions take place online, this is not only good for elders, but for everyone. So when you can, go outside and meet your neighbors!
🤰 Access to (reproductive) healthcare: Earlier in the post, I mentioned that race-based diagnostic criteria can have majorly adverse effects for pregnant people, and it’s a fact worth repeating. Two years ago, I reported in my very first TNG post that Black pregnant people are at least three times more likely than others to experience injury or death during childbirth than others – and this is in America, where maternal morbidity and mortality rates are higher overall than most other high-income countries. Countless of these injuries and deaths could have been prevented if iron-deficient anemia was screened for during prenatal visits and actively monitored during and after childbirth. Compassionate prenatal care from clinicians – including actively listening to and documenting pregnant patients’ household circumstances, environmental exposures, and symptoms of iron deficiency – can also help to reduce the likelihood of preterm birth and low birth weight.
🩸 Beyond pregnancy, people assigned female at birth are more likely to have iron deficiency due to blood loss during menstruation. While menstruation is, indeed, a “natural” process, the amount of blood loss experienced during menstruation can be a byproduct of injustice. Research suggests that poor diet (notice that food insecurity is a recurring character in this post!) can lead to heavier and longer periods, as well as spotting in between periods. Some forms of stress may also be associated with heavier periods, though more definitive research is needed [archived link] to establish stress as a clear and direct cause. In any case, while heavy menstrual bleeding is not always avoidable, it can be helped with proper healthcare. There are many proven medical treatments for heavy periods, but due to broader cultural stigmas surrounding periods, many people (particularly young women and girls) hide the extent of their bleeding out of shame, a lack of education around periods, or the absence of a reliable support network. The longer that heavy bleeding is hidden, the longer blood loss persists, and the higher the long-term risk of iron deficiency.
➡️ For women and people assigned female at birth, the most important thing to remember is that menstruation does not have to be an experience of suffering, so if you are bleeding heavily, asking for help can help to manage this! The best thing we can ALL do is provide safe spaces for conversations around diverse experiences with menstruation and offer ourselves as judgment-free, affirming resources.
The bottom line: As is the case for many conditions, iron deficiency can often be traced back to social inequities that trickle into our individual and collective health behaviors and outcomes. However, the fact that these inequities are socially constructed means that we have the power and responsibility to DEconstruct them. In contrast to genetic and other biological determinants, social determinants of health remind us that many of the illnesses that impact ourselves and our communities – most especially marginalized communities – are not naturally occurring, and with ongoing prevention and advocacy efforts, they can be stopped in their tracks. Therein lies our hope!
From one iron-deficient nerd to another: Stay safe, and stay well!
Those Nerdy Girls
**Various social factors can also lead you to have too much iron in your blood. This condition, called hemochromatosis [archived link], is not the focus of this post, but can be covered in a future post upon request!
Further Reading:
Read TNG’s previous series of posts on iron by Nerdy Girl Daphne!
Should I take an iron supplement?
Which iron supplement is best?
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Healthy People 2030’s objective to reduce iron deficiency in females of childbearing age [archived link]
More information on iron deficiency in older adults
More information on how to detect and prevent iron deficiency [archived link]
