The Importance of Social Determinants of Health and Achieving Health Equity
As a nurse practitioner, my interest in social determinants of health and gaps in care has grown the longer I have worked, seeing how there is only so much one can do when only treating the surface problems a patient presents with. Social determinants of health, as defined by the U.S. Department of Health and Human Services, are “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks”. These social determinants can be grouped into five key domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context.
Examples of social determinants of health include access to nutritious foods and physical activity opportunities, polluted air and water, safe housing and transportation, racism and discrimination, and language and literacy skills. Each of these factors, or a combination of them, can have a significant impact on an individual’s health outcomes. However, these social determinants are not always taken into consideration when providing healthcare, which is a critical oversight.
For instance, if you are treating a patient who requires a course of antibiotics to treat an infection but does not have stable housing or finances, expecting them to consistently take the medication as directed is unrealistic – their priorities are likely putting food on the table and ensuring they have a roof over their head. Ignoring these social determinants is not only inappropriate, but negligent. Achieving true quality healthcare requires addressing the various factors inhibiting a patient’s health, not just providing a prescription.
Achieving Health Equity
The Institute of Medicine (IOM) has several recommendations for addressing health disparities and moving towards health equity. Two recommendations stand out:
- Increase awareness of racial and ethnic disparities in healthcare among the general public and key stakeholders. This could involve utilizing media outlets, creating educational content, and engaging policymakers to shed light on these issues.
- Increase the proportion of underrepresented racial and ethnic minorities among health professionals. Minority healthcare providers often have a deeper understanding of the challenges their patients face, and their presence can foster increased trust and comfort in the patient-provider relationship.
These are just two ways to work towards health equity. The key is recognizing that social determinants of health are a critical factor in patient outcomes, and addressing them must be a priority for healthcare providers and the broader healthcare system.
Conclusion
Social determinants of health are the “elephant in the room” that cannot be ignored. By increasing awareness, engaging policymakers, and diversifying the healthcare workforce, we can make progress towards achieving health equity and ensuring all patients receive the comprehensive, equitable care they deserve.
References:
1LastWeek Tonight. (2019 August 19). Bias in medicine: Last Week Tonight with John Oliver (HBO). [Video]. YouTube. https://www.youtube.com/watch?v=TATSAHJKRd8&ab_channel=LastWeekTonight
2Tedx Talks. (2012). A Recipe for Health Equity in the 21st Century: Renaisa Anthony at TEDxOmaha.
3DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nurse Outlook, 62, 219-224.
