By OMOBOLANLE AGBOOLA

Income insecurity, transportation and social isolation are major drivers of poor health across communities.

Our study examined the impact of social determinants of health, SDOH—specifically economic and environmental conditions—on individuals and communities in Nigeria from a whole-person health perspective, with a focus on the post–COVID-19 period. Using a cross-sectional design and a whole-person approach that included biological, behavioural, social, and environmental factors, we employed the health informatics tool MyStrengths+MyHealth to assess individual Strengths, Challenges, and Needs. Self-reported data were collected from 180 participants across various communities in Lagos, Nigeria, using non-random sampling methods.

Results

Examining whole-person health, participants in both settings reported key Strengths, most notably Hearing (n=134, 83.8%) and absence of Substance Use (n=131, 81.9%). The most common Challenges were Income (n=141, 88.1%), Exercise (n=116, 72.5%), Connecting (n=106, 66.3%), and Safety at work and home (n=102, 63.8%). Corresponding Needs were highest for Income (n=121, 75.6%), Connecting (n=101, 63.1%), Socializing (n=101, 63.1%), and Safety at work and home (n=97, 60.6%).

Focusing on economic and environmental conditions (Income, Exercise, Socializing, and Connecting), rural participants reported slightly more Income Challenges (n=71, 88.8%) compared to urban (n=70, 87.5%). Urban participants reported more Challenges with Exercise (n=60, 75.0%) than rural participants (n=56, 70.0%). Socializing Challenges were similar in both groups (urban: n=50, 62.5%; rural: n=51, 63.8%). Rural participants reported more Connecting Challenges (n=58, 72.5%) than urban (n=48, 60.0%). Notably, the margins of these Challenges were similar across rural and urban populations, a shift from patterns typically observed before the pandemic

Overall Top 10 Challenges

The most frequent Challenges across both populations were related to income. A majority of participants (n=128, 80%) reported “not enough income,” more than half (n=87, 54.4%) indicated they could “only buy what they need,” and nearly half (n=78, 48.8%) found it “hard to buy the things they need.” Within the Socialising concept, 55.6% (n=89) experienced “limited social time.” For Connecting, 48.1% (n=77) reported “transportation barriers,” and 41.3% (n=66) found it “hard to access services” they need. Challenges within Exercising included participants who “do not like their exercise plan” (n=66, 41.3%) and those reporting sedentary behaviour, “sit too much” (n=58, 36.3%). For the Safe at Home and Work concept, 43.8% (n=70) reported environmental “pollution,” and 37.5% (n=60) experienced “dangerous traffic.”

Implications for Health

This study has important implications for health. Poverty adversely affects physical and mental health, nutrition quality, housing conditions, medication affordability, access to healthcare, and social well-being. Financial insecurity poses immediate health risks and contributes to long-term adverse outcomes, including higher mortality and morbidity. Barriers to social connection—such as transportation challenges, dangerous traffic, and pollution—reduce social participation and quality of life, undermining overall well-being. These challenges often lead to distress, exhaustion, and hopelessness.

Enhancing financial stability, transportation access, social services, and economic security is essential to improving the well-being of Nigerians. To mitigate these effects, coordinated federal, state, and institutional support is needed to address poverty, social disparities, health inequities, and their consequences. Poverty is a complex issue that requires sustained public and governmental action, framed within the principles of social justice and health equity. Addressing social determinants of health is essential to reducing adverse health outcomes and providing targeted support.

•Agboola, a Nursing PhD student, wrote from the University of Minnesota, USA.