Health is largely determined by factors outside of the healthcare system. The determinants of health are defined by the Government of Canada as a broad range of personal, social, economic, and environmental factors that determine and influence our health.
The social determinants of health are described by the World Health Organization (2013) as
“the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics”.
In Canada, as listed by the Canadian Mental Health Association, the social determinants of health include:
Aboriginal status
Disability
Early life
Education
Employment and working conditions
Food insecurity
Health services
Gender and gender identity
Housing
Income and income distribution
Race
Sexual orientation
Social exclusion
Social safety net
Unemployment and job security
This video "Measuring Health Inequalities: An Introduction" by the Canadian Institute for Health Information (2018) provides insight into a health inequality present in children of differing income levels. The importance of analyzing data beyond averages in order to capture disparities is highlighted.
We know these health inequities exist and determinants of health are complex and intertwined – it can be intimidating to address these issues, but it is imperative they be addressed for optimal outcomes. What action can health professionals take in order to address disparities from the social determinants of health and make a positive impact on health outcomes and promote health equality? A study by Andermann (2016) offers strategies to incorporate ways of addressing and positively influencing the social determinants of health at the patient level, practice level, and community level.
Our interactions with patients must encompass the full situation and social background in order for appropriate, attainable treatment. Asking patients about their social history/challenges, in a sensitive way, is necessary in order to provide helpful advice, appropriate referrals to services, and facilitating access to additional resources. Clinical flags may alert physicians to address social challenges and prompt connecting patients to various support resources. Often times, it is a health professional who may notice a missing support and inform an unaware patient of available funding, benefits, or programs they are entitled to.
At a practice level, health professionals should focus on reducing barriers for vulnerable groups to accessing care. Patient navigators (potentially volunteers), employment consultants, and individual care managers should be included to assist patients to access resources. Some additional suggestions include providing bus fare, child care services, or extended clinic hours to reduce potential barriers. The design of clinical practice should accurately reflect the needs of all people.
At a community level, partnerships and engagement of other sectors is necessary to improve population health. Health professionals can advocate for collaborative initiatives and conduct locally relevant research to promote more supportive environments for health. Andermann (2016) indicates, “physicians and allied health workers can serve as important catalysts for change to spark community-level shifts in ways of thinking and acting by initiating a dialogue and helping identify local solutions”.
In order to effectively manage disease and improve health, an approach must identify and respond to the social determinants of health. There is never a quick fix with something as complex as health. It is the role of healthcare professionals to inquire, connect, support and advocate, understanding the hidden social challenges our patients may face. Health inequities are often avoidable - they need to be recognized with a deeper understanding and responded to with support and advocacy for improvements.
References:
Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association Journal, 188(17–18), E474–E483. Retrieved from http://www.cmaj.ca/content/188/17-18/E474
Canadian Mental Health Association. (n.d.). Policy papers on the social determinants of health. Retrieved February 13, 2019, from https://ontario.cmha.ca/provincial-policy/social-determinants/
CIHICanada. (2018, November 09). Measuring Health Inequalities: An Introduction. Retrieved from https://www.youtube.com/watch?v=mMPZUZ6koVs
World Health Organization. (2013, May 07). Key concepts. Retrieved February 13, 2019, from https://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en/
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