Why Social Determinants of Health Matter in Clinical Care
By Lucy Masto, Monica Oxenreiter, and Nena Kotsalidis
Dr. Leonard Egede introduced many factors that affect a person’s health, and how they can be used to improve individual care
Social determinants of health (SDOH) describe the interaction between social, economic, and environmental factors and how they can influence a person’s health outcomes. While many different frameworks are used to understand SDOH, the World Health Organization’s model (image on page 6) is often used because it includes important factors like government policies, socioeconomic status, and biology.
What have we learned from social determinants of health?
Dr. Leonard Egede, the Chief of General Internal Medicine at the Medical College of Wisconsin, explained that healthcare professionals should think about all aspects of a person’s life when providing care. For example, he encouraged healthcare professionals to create treatment plans that consider all factors influencing a person’s health, beyond their medical information. No prescription can address every need, so it is important to put medical information into a broader context. Similarly, focusing on providing care informed by social needs can benefit everyone in the healthcare system. For example, this type of care can be improved by helping someone access transportation to get to their health appointment or by providing a translator for someone with a language barrier.
Last, Dr. Egede reinforced the idea of social needs-targeted care: in addition to understanding what challenges a person faces in accessing care, we must find ways to address those barriers. For example, if a patient can’t afford their healthcare, setting them up with a patient assistance program or other affordability options could be hugely beneficial. The most important aspect of this type of care is understanding that each person is unique and requires individual treatment based on their social, behavioral, economic, and environmental background.
Past studies on SDOH have shown that long-term stress is a common variable that can negatively affect someone’s health. Finding ways to limit the stress surrounding a person’s medical needs can help people focus on their health. According to Dr. Egede, healthcare professionals should spend at least five minutes of each appointment asking meaningful questions to find out more about the person’s life. This is particularly important for people living with diabetes, as many factors can influence health beyond A1C levels. Chronic conditions are particularly influenced by SDOH, so people with these conditions need invested healthcare professionals who can help them navigate their care in a personal way.
Screening for social determinants of health
Dr. Egede emphasized the need to improve screening tools for SDOH. Currently, three major screening tools are used by clinics to identify SDOH: The Accountable Health Communities Health-Related Social Needs Screening Tool, PREPARE, and CLEAR. These screening tools look at factors other than a person’s medical history that likely affect their health. Studies have found that environmental, social, and economic factors can affect a person’s ability to care for themselves; in people with diabetes, this has a significant impact on a person’s ability to manage their blood sugar levels. Through screening, healthcare professionals can help create a more accurate picture of what challenges may exist and establish an individual response to those issues.
A closer look at neighborhoods and environments
Where someone lives and their surrounding environment affect not only their day-to-day life but also their long-term health. A study found that people living in more walkable neighborhoods did more physical activity and showed lower rates of obesity. People living in less walkable neighborhoods –whether due to concerns of safety or the layout of the area – tend to be less physically active. This type of discrepancy leads to higher chances of developing obesity, diabetes, and hypertension.
A person’s environment not only includes the physical aspects of their environment but also their surroundings, including the air they breathe and the water they drink. For example, air pollution due to human activities (like deforestation and burning fossil fuels) accounts for 9 million deaths per year. Air pollution can lead to respiratory disease and heart disease, cancer, and other conditions. Water contamination can also negatively affect health. Contaminated water can lead to waterborne diseases such as cholera and hepatitis A. Constant exposure to these air pollution, contaminated water, and other environmental conditions can lead to an increased risk of death and disease. Communities with lower average incomes are disproportionately affected by poor environmental circumstances.
A starting point for addressing social determinants of health is to begin to notice the factors in your own neighborhood that may contribute to better or worse health outcomes. Some questions to consider are:
Are grocery stores easy or hard to get to from your home?
Do you feel comfortable walking around your neighborhood?
Do you have a local park near you that you feel comfortable going to?
Can you pinpoint the closest factory or industrial complex that might produce pollution?
How can you be the best advocate for your own health?
Be honest with your healthcare professional; they need a full picture of your life and background to make the most informed recommendations for your care. Similarly, there may be aspects of your life that you don’t realize affect your health. By being honest and open, and giving your healthcare professional the most information you can, you can work as a team to help improve your health.
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