Social Determinants to Health?What does it mean?

Social Determinants of Canada

1. Income and Income Distribution 2. Education 3. Unemployment and Job Security 4. Employment and Working Conditions 5. Early Childhood Development 6. Food Insecurity 7. Housing 8. Social Exclusion 9. Social Safety Network 10. Health Services 11. Aboriginal Status 12. Gender

These determinants of health are important as it relates to social factors which influences behaviors, lifestyle choices and illuminates societal disparities. For example, access to healthy foods is a constraint if individuals are restricted by economonic factors, education (healthy vs. unhealthy foods) and/or culture (nurturing environment). There is depth to this as well, in which a person of greater weight is a culturally associated mark of ‘beauty’ in some societies. The social determinants of health are a topic from which healthcare professionals can understand someone’s societal factors as it relates to their health or worldview.  

Pega, Valentine, Rasanathan, Hosseinpoor, Torgersen, Ramanathan, and Neira (2017) suggest that the determinants (health) accumulate over time to shape the health of population groups according to their social status. Therefore, changes in health equity as a result of interventions or policy frameworks will improve social determinants of health.

They have divided them in different groups of interventions:

Governance interventions: defined as political and decision-making structures and processes that improve health equity, such as whole of-government or multi-sectoral committees, funds or plans, or human rights legislation.

Socioeconomic interventions: defined as those policies and programmes that allocate social and or financial resources to improve health equity. Such interventions could improve early child development, education, living wage, pay equity and social protection.

Environmental interventions: defined as policies or programmes for the built or natural environment that improves health equity. Examples of such interventions are slum upgrading, air and drinking water quality improvement, sanitation and hygiene improvement and climate change mitigations and adaptations

(Pega, Valentine, Rasanathan, Hosseinpoor, Torgersen, Ramanathan & Neira, 2017)

The interventions were interesting and as a health care professional I can see the importance of them and I can also address the notion that one’s health status is based on their relation to the social determinants of health.  

Thesis and Regenstein (2017) suggest that societal factors may undermine health and it is commonly undetected because routine for social determinants of health is still not routinely implemented in healthcare.  The authors focused on ‘medical-legal partnerships’ (MLPs) approach to addressing social determinants of health. The belief is that addressing these determinate of health will ultimately reduce healthcare costs. However, a reason for the lack of screening may be logistical constraints in establishing and following through on a screening process.

In a randomized control trial involving eight urban community health centres in Boston, Mass. It is found that the use of a screening tool and referral system increased access for families to health care resources. The use of legal services as per the approach for MLPs may resolve many issues if clients are screened for it. A national survey, reported in this article suggests 79% of organizations have active screening protocols for social determinants of health. 48% of healthcare professionals screen for domestic violence/abuse. However, conditions triggered regularly such as asthma, are screened less than 25% of the time. However, it is found that the screening protocols are not being robustly used.

The efforts of screening may provide social services and benefits that would have transformative effects in the lives of patients. Urban areas in particular continuously have outstanding needs. The primary illness of an individual requires treatment; however, societal factors must also be explored (Daniel, Bornstein & Kane, 2018). Hospitals, organizations have legal services and ability to out-reach services that will improve health outcomes and quality of people.

Resources

Daniel, H., Bornstein, S. S., & Kane, G. C. (2018). Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper. Annals of Internal Medicine, 168(8), 577. doi:10.7326/m17-2441

Government of Canada. (2018, May 22). Social determinants of health and health inequalities. Retrieved from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Pega, F., Valentine, N. B., Rasanathan, K., Hosseinpoor, A. R., Torgersen, T. P., Ramanathan, V., & Neira, M. P. (2017). The need to monitor actions on the social determinants of health. Bulletin Of The World Health Organization, 95(11), 784-787. doi:10.2471/BLT.16.184622

Theiss, J. & Regenstein, M. (2017). Facing the Need: Screening Practices for the Social Determinants of Health. Journal Of Law, Medicine & Ethics, 45(3), 431-441. doi:10.1177/1073110517737543