Traditional physical health care misses its mark when we ignore the social determinants of health, particularly in the context of vulnerable populations. Identifying and rooting out health disparities has been a challenging task, and despite decades of effort, these inequities continue to be fed and sustained by complex, interconnected factors.
That is why expanding health assessments to include the entire social environment is a necessary commitment that can expose the underlying problems that impact health in a way that a purely physical assessment cannot accomplish.
Let’s consider a ubiquitous example: poverty. The lack of bare necessities, social relegation, and unemployment – these are just some of the factors that come packaged with poverty, making it harder for people to remove themselves from their situation, while simultaneously increasing the threat of health-related consequences.
According to its 1948 constitution, the World Health Organization definition of health encompasses not only physical, but also psychological and social well-being. Embracing this broader interpretation of health encourages extending the normal boundaries of medical evaluations to include social determinants.
The U.S. Government’s Healthy People 2020 initiative has set a goal to create health-promoting social and physical environments. It recognizes that health is determined by access to social and economic opportunities, resources available in our immediate environments, quality of schooling, safety at work, cleanliness of water, food, and air, and our social milieu.
The initiative outlays five key social determinants of health (SDOH): economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. For example, economic stability includes consideration for poverty level, employment options, food security, and housing stability. It recommends the use of Health Impact Assessments and an adoption of a “health in all policies” strategy.
The CDC has published several useful resources on SDOH with the purpose of turning words into action. These include an at-a-glance reference that describes ten essential public health services that need to be adapted to address social determinants of health. These include monitoring health status to pinpoint and solve community health problems, investigating health problems and hazards in the community, public education, etc.
When brought to the level of the practitioner, incorporating SDOH into practices is a very big challenge. In a detailed resource created for practitioners, the CDC suggests that practitioners can play a crucial role in the process of mitigating disparities by “engaging the community, identifying needs, conducting analyses, developing partnerships, as well as implementing and evaluating evidence-based interventions.”
Despite the planning and initiatives, there is deep concern in the medical community that practitioners are ill-equipped to handle the incorporation of SDOH into their clinical practices. They believe that, if not done correctly, screening for SDOH can have unintended and unethical consequences. For example, if a physician identifies a social problem as the root of a health issue, it creates an ethical dilemma if they cannot provide a solution for the patient – something they are not empowered to do.
At MMB Advantages, we believe that building bridges across different sectors that address SDOH is a crucial, albeit herculean, task that must be implemented to improve the health profile of society at large, particularly within communities facing the biggest disparities.