Social determinants undermine patient health

From Texas Medical Association

A one-month-old baby suffered a terrible rash all over her body. Her physician determined the condition was not a result of a medical issue but of her family’s living conditions under Texas’ sweltering August heat: A broken air conditioner forced the family to open its windows, leaving the baby vulnerable to constant mosquito bites.

For many patients, roadblocks - like a broken air conditioner neglected by the landlord - are the social determinants of health that impact their well-being and quality of life, and can harm their health. Physicians say the ongoing COVID-19 pandemic also revealed how deeply social determinants disproportionately affect certain populations. For example, due to chronic structural inequities that affect well-being, such as lack of safe housing and access to medical care, and certain jobs that carry a higher risk of disease exposure, COVID-19 has disproportionately sickened, hospitalized, and killed people of color and those with low incomes.

“Just one nonmedical problem can set off a chain reaction of health crises,” said David Lakey, MD, vice chancellor for health affairs and chief medical officer at The University of Texas System and a consultant to the Texas Medical Association (TMA) Council on Science and Public Health. “All those things in [a patient’s] environment can have a profound effect on whether they can live a healthy life or not.”

A 2020 survey found that 73% of physicians say social determinants of health, such as access to healthy food and safe housing, would drive demand for health care services in 2021, according to The Physicians Foundation, which is supported in part by TMA. Other determinants affecting patient health include access to transportation and technology, health care costs, language barriers, and literacy. These challenges can undermine good medical treatment because they’re already affecting the patient, said Waco family physician Tim Martindale, MD. “As physicians, we are trained in how to figure out and treat challenges in health for our patients,” he said. “But sometimes it is the simple, practical things that limit our patients’ health.”

More physician practices and health care systems are screening patients as a first step to address social determinants. While physicians cannot address all social determinant factors affecting their patient’s health, the screening process can reveal what social services and assistance would improve patient health. “The diagnosis and the plan to address the problem can be enhanced by understanding some of the social needs, i.e., social determinants, that can get in the way, or may have already gotten in the way of making this person as healthy as they could be,” said Eduardo Sanchez, MD, chief medical officer for prevention and chief of the Center for Health Metrics and Evaluation for the American Heart Association, and also a TMA public health council consultant.

“This is not about ascribing fault as much as it is identifying factors that should be considered or addressed,” he said.

Texas physicians are taking notice of the effects of social determinants on their patients’ health, and seeking ways to address their impact by focusing on the health outcomes of patient treatment.

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