social determinants of health for fitness pros

As fitness professionals, there is an understanding that many factors outside of the gym impact your clients. There is a constant emphasis on helping clients with getting quality sleep, having adequate nutrition, and developing stress management skills in order to improve their health and wellness. Beyond these individual controllable factors are other factors that have just as much of an impact on the health and wellness of your clients. These factors are called social determinants of health.

(Dahlgren & Whitehead, 1991)

As the name implies, social determinants of health are factors in the larger, societal realm that have an impact on health and quality of life. These include:

• Economic stability

• Education access and quality

• Health care access and quality

• Neighborhood and built environment 

• Social and community context

Each of these conditions can have a profound impact on your clients’ abilities to show up, be consistent, and navigate obstacles. To understand how these factors impact clients, we also need to examine how the stratification of these factors affects health outcomes. 

SOCIAL STRATIFICATION

It’s important to note that all of these determinants of health are also highly socially stratified. What is social stratification? Social stratification is the acknowledgment that society, as a system, arranges categories of people into a hierarchy based on these different groups. This hierarchy involves things like power, status, wealth, and access to obtaining those things. The different points of stratifications or  groups we traditionally see examined are race, class, gender, sexual orientation, and able-bodied status. 

Social stratification directly affects your clients ability to have their needs met and how they navigate the social determinants of health. To explore this, we need to examine Maslow’s hierarchy of needs. 

Maslow’s hierarchy of needs states that in order for people to have certain basic needs met, like shelter, safety, and food before they can fulfill higher needs like prestige and self-actualization.

Maslows’ hierarchy of needs

You’ve likely seen the basic Maslow pyramid at least once and acknowledge its validity and existence. You probably even utilize some of these principles in your coaching!  For example, you may acknowledge that when your clients are struggling with their jobs, financial insecurity, or a major crisis - fitness has to look different and is a lower priority. You likely implicitly understand that basic needs come before higher needs. As we’ve discussed, these needs are heavily impacted by the social determinants of health. 

Stratification says that the access and ability of all people to meet those basic needs is...stratified! Meaning, it is unequal and not the same for every person who walks through your gym doors or sends you a coaching inquiry.

There is ample research on the distinct disparities in health outcomes for people of color, people in poverty, and people who are marginalized. This is not news. This is regularly acknowledged, studied, and taught to those in health-related professions. Where this isn’t taught, however, is in fitness because fitness certifications don’t address this.

Here are some examples:

1 https://www.cdc.gov/vitalsigns/aahealth/infographic.html#infographic 

2 http://stacks.cdc.gov/view/cdc/20865/cdc_20865_DS1.pdf

• Women, minority racial/ethnic groups (except Asian/pacific islanders), those with less education, those who spoke a language besides English at home, and those with disability were more likely to report fair or poor self-rated health, more physically unhealthy days, and more mentally unhealthy days than others.

You, as a fitness or wellness or nutrition professional, are trying to work at the basic needs level or above, therefore these inequalities come into play for your clients. For example, if you’re a nutrition coach and you have a client who does not have access to fresh produce because of food deserts, you should be able to coach them through other options.  If you’re a coach working with clients who have limited financial resources, you should be cognizant of not recommending modalities, accessories, etc. that are financially prohibitive and expand your toolbox of other more accessible options. If you’re working with clients who have a wide range of access and resource availability, suggesting that they cannot achieve results without buying organic and buying costly “superfoods” or supplements, is alienating and not helpful. The bottom line is you need to understand the context of the person in front of you in order to provide the best service and resources to that client. 

We’ll take a look at each social determinant of health one by one to examine how they show up in your clients’ lives and how they impact your job as a fitness professional.

SOCIAL DETERMINANTS OF HEALTH

Economic Stability

Economic stability is one the largest barriers to entry for clients who are looking to hire a fitness professional. Many clients feel that they can’t afford personal trainers or gym memberships and even if they can, they worry about their ability to continue to afford these things. Economic stability is also one of the biggest sources of stress for clients, especially those who work in environments where income is in constant flux. It’s important to remember that sometimes people have to move on or can’t commit to paying a certain amount, not because they don’t value you or your service, but because they have essential bills to pay for. 

Avoid shaming clients by insisting their priorities aren’t in line and instead, offer creative solutions. Reducing economic stress by providing those solutions is a difficult task to navigate, because as a fitness professional, you also need to make a living and charge appropriately. A sliding scale or scholarship based program can be potential options that can reduce financial stress while still ensuring you’re compensated for your time and skill. If those options aren’t conducive, you can provide a small packet of information for them to take as they leave you to ensure they can do what they need to do on their own. Providing information, education, and autonomy will always be a win for clients, regardless of their economic status.

Education access and quality

Many people walk into the gym having no clue what to do or why they’re doing it simply because they were never taught anything substantial about health and fitness. Early introductions to information about health and fitness also have a profound effect on the client’s narratives surrounding fitness, the gym, and health behaviors. For example, if a client did not have access to foundational information about nutrition, they may be more likely to come to you to chat about the latest fad diet. Rather than ridiculing them, offer education. You can explain to them why that diet may seem like a magical thing and how the reality is far different. 

Clients may come from a variety of educational backgrounds and as such, you should be able to adapt accordingly. Using similar language is an easy way to help clients feel more comfortable and provide better education. Remember, your clients don’t care about their Q angle while they squat, they care about being able to squat safely and effectively. 

Health care access and quality

Having adequate access to health care early in life is one of the largest predictors of future disease, illness, and poor quality of life. If clients lacked quality healthcare when they were younger, they may present with poor health outcomes and a very negative view of health-related behaviors. Keeping this in mind can be helpful when explaining and educating clients about different aspects of their health and how fitness can impact them. Clients without adequate healthcare access may also struggle with getting necessary preventative care that can impact their development of different ailments and illnesses. 

Avoiding shame here is critical, especially for those already marginalized by the healthcare system (i.e. people in larger bodies, BIPOC individuals, etc.) For clients without healthcare access, educating clients on positive health behaviors that they can do for themselves becomes even more important. Help clients learn how they can best care for themselves through supportive, educational reinforcement and resources. 

Neighborhood & built environment

Neighborhood and built environment have a large impact on whether a client even steps into your gym. For many groups, especially populations who are victims of red-lining and other social-environmental predatory practices, access to a gym or even a safe place to exercise outdoors is not a reality. Most fitness facilities are located in non-impoverished areas despite the fact that poverty is associated with significantly poorer health outcomes and as such, could use more resources that focus on health. Beyond fitness facilities, many clients will not have a safe place to exercise outdoors. Taking a walk is a simple, introductory exercise behavior that would seem to be for everyone; however, walking may not feel like a safe, or even practical endeavour, for those who live in areas that do not have the infrastructure to support it. 

These situations are where your creativity as a fitness professional can really shine. Client doesn’t have access to a gym? Get creative with movement they can do at home. Client doesn’t feel safe going for a walk outside? Find other avenues to encourage non-exercise movement and relaxation such as some gentle yoga.

Social and community context

The fitness community is largely white, heteronormative, and masculine which can make those who do not fit into those categories very uncomfortable. BIPOC individuals may not feel comfortable walking into a gym environment where no one looks like them or racist comments are seemingly tolerated (or even celebrated). Previous experience with non-safe fitness environments can hinder clients from trying again and discourage them from engaging in public health promoting behaviors all together.

Part of being a fitness professional is providing a comfortable environment for your clients and clients with previous negative experiences, BIPOC, and LGBTQIA+ clients are likely to feel uneasy in traditional, non-inclusive environments. Using appropriate pronouns, providing gender-neutral language and spaces, and refraining from making assumptions about ability or circumstances are easy ways to help clients feel more comfortable and included.

CREATING MORE ACCESSIBLE COACHING

The task of creating more accessible and inclusive coaching may seem daunting when there are so many factors to consider, but the good news is that awareness is the first step in creating better policies and environments. The most important thing when creating more accessible coaching is to listen, accept feedback, and course correct when you’re wrong (and you will get it wrong). Remember, this is not about you. It is about creating a safe, accessible, inclusive environment for your clients that allows you to help them thrive and achieve their goals. 

Here are some actionable tools to consider:

Representation:  Do you show a diverse and inclusive range of people on your social media or marketing?

If not…

• Is it because you don’t have a diverse base of clientele/patrons?

• Is it because you feel conventional/fit bodies sell better?

Showcasing a genuinely diverse range of people with various abilities, body types, races, genders, etc. is a way to help people feel comfortable. There is a difference between being tolerated and being welcomed; aim to make people feel welcome.

Language: Language and communication are key to any coaching experience. These are a few areas for potential improvement that can help create a better environment:

• Interpersonal language

  • Pronouns (ask for on intake forms, use proper pronouns)

  • Language around bodies (“good”, “bad”)

  • Language around exercise (punishment-based language)

• Marketing/Copy language

  • Shame based sales rhetoric (

  • Privileged rhetoric (assuming everyone who can’t afford you is just “lazy”)

  • “Transformation” language (i.e. “after” being morally better than “before”)

As a fitness professional, you are working with people and their health and that should not be taken lightly. Aim to serve your clients and their full humanity. Meet them where they’re at, in their context, and move forward with integrity and inclusivity.