When we think of our health, we tend to associate its causes with our diet, the environment, our exercise regime, and other such biological or ecological causes. However, social factors are important factors that shape your health
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Social determinants of health (SDOH)
Physicians have developed a notion of what they call, “social determinants of health” (SDOH). SDOH refers to the economic and social conditions that influence a person’s health, such as economic stability, food security, education, influence, health care access, neighborhood and physical environment, as well as social and community context. These factors can, if positive, promote a person’s health status, if negative, they can harm your health, leading to disease, injury, or just vulnerability to disease.
How these factors appear in society is driven by public policies. In other words, these health outcomes are not a result of natural factors, rather, they are the result of policies, economic arrangements, and politics. The World Health Organization (WHO) believes that, “the social determinants can be more important than health care or lifestyle choices in influencing health”.
Food insecurity is a good way to illustrate the impact of policy on health. Laura Zimmermann, MD, the interim division chief of general internal medicine at Rush University Health System, gave a webinar in which she discussed a 43-year old patient who had lost 30 pounds in the last year. That patient, an adjunct professor, has asthma, hadn’t started a diet, had a BMI of 18, normal vital signs, and, after her checkup, Dr. Zimmermann was unable to find anything wrong with her.
The patient’s earnings were below the federal poverty line, and she did ot have access to as much food as she needed, and was worried about that. When Dr. Zimmermann referred her to care management and social work, she was provided with a food assistance card, and given referrals to food pantries in her area. When she had her next examination, she had gained five pounds and her overall health had improved. The story demonstrates how an annual physical exam can find causes of illness that stem, not from natural causes, but from social ones.
Sadly, that patient’s experience is felt by about 135 of American households, who suffer from food insecurity. Food insecurity disproportionately affects people from historically marginalized communities.
While Dr. Zimmermann’s patient was an adjunct professor; she did not have sufficient positive SDOH in her life because her income was lower than her status suggested. Doctors, therefore, have to look more carefully at the entire ecosystem that makes up a person’s life, because, while a person may seem to be doing alright, they may actually be struggling, and those social determinants may drive their poor health.
Dr. Zimmermann’s webinar was part of the American Medical Association’s (AMA) STEPS Forward program, which suggests that doctors take the following eight steps to help tease out SDOH:
- Understand and speak with the community
- Meet with important leaders
- Assess your practice’s readiness
- Choose and define a plan
- Assess a patient’s SDOH
- Match patients with SDOH resources
- Evaluate outcomes and refine the plan
- Celebrate success!