“Social determinants of health” (SDOH) is a hot topic these days and not one that’s likely to go away any time soon. That’s because our healthcare system continues to struggle with healthcare disparities, leaving consumers from adverse socioeconomic scenarios to suffer for it. Think about it. If a person can’t afford fresh fruit, how can he comply with the nation’s healthy eating guidelines? If a mom can’t read, how can she give her child the correct dose of medication?
It’s issues like these that keep health equity advocates up at night. To better understand the situation, let’s look at where health begins. HealthyPeople.gov, a division of the nation’s Office of Disease Prevention and Health Promotion, says: “Health starts in our homes, schools, workplaces, neighborhoods, and communities.”
HealthyPeople.gov goes on to say, “Our health is also determined in part by access to social and economic opportunities; the resources and supports available in our homes, neighborhoods and communities; the quality of our schooling; the safety of our workplaces; the cleanliness of our water, food and air; and the nature of our social interactions and relationships.”
No one sees the disparities more clearly than healthcare providers in the trenches. In a New York Times article, Dr. Dhruv Khullar witnessed the inequities firsthand as a medical resident:
“…what strained our abilities was not our patients’ medical complexity, but their social problems: They were poorer, less educated, more isolated, from rougher neighborhoods. We quickly learned that while it’s hard to dose insulin, it’s harder still for a patient who speaks no English, has no refrigerator and regularly has his medications stolen.”
The status quo much change, but how? For starters, all health institutions must play a part. That includes health plans, healthcare organizations, community resources and medical providers. An article published in the American Journal of Managed Care says, “First, health plans have to recognize that a collaborative approach is absolutely essential to success. No one organization can manage social determinants of health and population health holistically. Rather, health plans and health systems must develop a community accountability model and build coalitions with their community partners.”
HealthyPeople.gov suggests health institutions focus on these five key areas:
- Economic stability — Address employment issues, food scarcity, poverty and housing instability
- Education — Start with early childhood education and development, and provide support for high school graduation, language and literacy and enrollment in higher education
- Social and community context — Eliminate discrimination, lower incarceration rates and encourage civic participation and social cohesion
- Health and healthcare — Make healthcare and primary care accessible and promote health literacy
- Neighborhood and built environment — Lower crime and violence, raise housing quality, improve environmental conditions and provide access to foods that support healthy eating
Health equity for all people is a lofty goal. We will only achieve it with strategic partnerships, a collaborative effort and an urgent commitment to closing the gap between the healthcare ecosystem and people in need. It’s critically important to recognize the factors that impact population health in order to create targeted, effective programs that improve health outcomes and drive positive behavior changes.
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