05/06/2024
The Social Determinants of Health: What Medical Professionals Need to Know
Provided by OSMA's exclusively endorsed partner for medical liability insurance, The Doctors Company
Each day, patients’ health is affected—for better or for worse—by factors like income, education, access to fresh food, access to green space, or access to a safe living space and neighborhood. Healthcare professionals witness how these aspects of a person’s day-to-day living environment, together known as the social determinants of health (SDOH), influence the arc of a person’s life.
They also see how negative SDOH like poverty and racism contribute to disparities in healthcare outcomes. For instance, in the United States, Black and Hispanic patients experience higher rates of many adverse surgery-related safety events relative to White patients at hospitals across all safety grades.
Fortunately, clinicians and organizations can craft more effective and equitable care interventions by elevating their awareness of key aspects of SDOH.
For individual clinicians, this heightened awareness coalesces into the provision of more holistic care. Organizations can also commit to collaboration, outreach, and advocacy for measures that make a dent, not only in individual patients’ care experiences and health outcomes, but in the root causes of SDOH.
Interconnectedness
“Social determinants of health are not isolated variables,” says Shelise Valentine, RNC, MSN, Director of Clinical Education, Healthcare Risk Advisors, part of TDC Group. “They are interconnected and often influence each other. For instance, income can affect access to education, nutritious food, healthcare services, and quality housing. Similarly, education can influence job opportunities and income.”
These intersections create a complex web of social factors that together shape an individual's health. Acknowledging these connections is vital for effectively addressing health disparities.
Health Disparities
SDOH are significant contributors to health disparities, which are avoidable and unjust differences in health outcomes between different population groups. For instance, relative to White patients, Black and Indigenous patients are two to three times as likely to die from complications related to pregnancy. These disparities often mirror societal inequities, so efforts to reduce health disparities must consider the broad spectrum of social determinants, from economic factors to cultural norms and environmental conditions.
Healthcare professionals are ready to engage in this effort, says Elizabeth Y. Healy, Vice President of Government and Community Relations for The Doctors Company, part of TDC Group. Yet in the face of such broad systemic issues, “What they don’t always understand is what they could or should do, specifically, to support equitable care and treatment in the face of inequitable wider conditions.” For many healthcare professionals, getting a grip on SDOH feels overwhelming.
Holistic Care
By evaluating social determinants, practitioners can offer care that is centered on the patient and considers the wider context of their lives, which is commonly described as holistic care.
Reflective listening forms the foundation. In spite of best intentions, relationship building-blocks can get short shrift when healthcare practitioners are rushed by throughput expectations—it can feel like there’s no time to hear the patient’s story.
Bridget O. Howard, DNP, CNM, FACNM, Manager for Advanced Practice Providers in Women’s Health at the Hospital of the University of Pennsylvania and a member of TDC Group’s APC Advisory Board, emphasizes that healthcare professionals need “the time to ask the difficult questions” for their conversations to encompass the social determinants of health, not to mention training that empowers them to be “comfortable with asking those questions.”
This is where organizational support comes in:
- How care teams are structured affects practitioners’ ability to form relationships with patients, which affects their ability to provide holistic care. Team-based care modelscan promote the formation of stronger patient relationships. Further, healthcare systems that have more closely integrated social workers into care teams have found that social workers can assist with assessing food insecurity, filling transportation gaps, and other SDOH-related patient needs that clinicians see every day.
- Some organizations are directly addressing shared local SDOH. For instance, healthcare systems operating where grocery stores are distanthave begun locating nutrition-focused markets on-site. Some even offer healthy-cooking classes. Others may partner with a local food bank or food pantry to offer food on-site to patients who struggle to afford it, says Dr. Howard.
Policy Changes
Policy-driven efforts to address SDOH are designed to, over time, encourage access to care, which helps to gradually erode certain disparities.
- The Joint Commission, a widely recognized independent accrediting body for healthcare organizations in the United States, has introduced new requirementsto address healthcare disparities. These include the collection of patient race and ethnicity information and prohibiting discrimination.
- The Centers for Medicare and Medicaid Services’ (CMS’) 2023 final rule focuses attention on SDOH, and the CMS Framework for Health Equity 2022–2032addresses priorities like expanding the collection and reporting of equity-related data, addressing causes of disparities within CMS programs, and building the capacity of healthcare organizations to reduce disparities in care and outcomes.
In many organizations, nurses’ everyday workflows may already align with some new policy requirements. For instance, nurses are accustomed to asking patients questions regarding their lifestyle, stress level, diet, alcohol consumption, physical activity, etc. Therefore, healthcare organizations and systems can incorporate questions that screen for SDOH such as food insecurity. For instance: “How hard is it for you to afford and access the very basics like food, housing, and medical care?” These sorts of screening questions assist nurses in caring for patients—and help organizations better understand the needs of their patient populations.
Practitioner Advocacy
Many clinicians are ready to address the root causes of care disparities as they connect to SDOH. Ms. Valentine is an experienced provider of safety education for labor and delivery teams who also has substantial experience in the emergency department, and she describes adverse SDOH, and interventions that address them, in terms of a kettle on a hot stove: “You hear the kettle and it’s screaming. You can take the top off the kettle, but the fire’s still going, right? We need to turn that fire off.”
With that in mind, healthcare practitioners can advocate for their organizations to participate in proven programs that address SDOH. One example is the HealthySteps program, which supports parents who have experienced childhood trauma in managing their stressors and providing secure attachment to their kids. The Montefiore Health System and others are inviting parents of their pediatric patients to enroll.
Informed healthcare practitioners can advocate for policy changes, contribute to community outreach efforts, and collaborate with interdisciplinary teams and community organizations to address social determinants and promote health equity. Dr. Howard says, “We’re at the health department in Philadelphia. We’re advocating and getting in the mayor’s office. We are at the state level, and we’re at national levels . . . We’re comparing notes with colleagues who sit on national boards.” Through conversations that cross regions, roles, and specialties, healthcare professionals are relaying insights “either down to our teams or up to our administration. Both of those directions are needed to ensure we’ve got the best outcomes for our patients.”
Comprehending SDOH entails understanding their interconnected dynamics, identifying their part in propagating health disparities, recognizing the pivotal function of healthcare professionals in managing these factors, keeping up with the most recent regulatory modifications, and appreciating the significance of holistic care. Individuals can encourage their institutions to participate in productive efforts. For instance, TDC Group’s community investment program is centered around addressing SDOH, including health equity and access to care.
Together, these insights can help guide more effective and equitable health interventions, ultimately contributing to improved population health and well-being.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
The opinions expressed here do not necessarily reflect the views of The Doctors Company. We provide a platform for diverse perspectives and healthcare information, and the opinions expressed are solely those of the author.