Recognizing the Social Determinants of Health
Have you heard about the social determinants of health? Health.gov refers to social determinants of health as “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.”
Lynley Holman, MD, FACOG, with Lawrence OB-GYN Specialists, is extremely passionate about the social determinants of health and how they can affect a person’s health and their ability to be healthy.
“I think it is important to address the social determinants of health because people do not live in disease,” Dr. Holman said. “Medicine has often become so focused on data collection, turning in insurance and needing to have a diagnosis. We don’t live in a disease, we live with a disease or condition. What we live in is a neighborhood, which costs money, which you have to earn to live there. It is important to address this subject because you cannot have a healthy person if they are worried about where they will sleep if they are socially isolated and cannot afford medication or good housing.”
Dr. Lynley Holman
She said it is important to remember this idea that we live in a community and do our best to handle a condition or disease state. Dr. Holman said the social determinants of health fall into five categories:
- Economic stability
- Access to education
- Access to good and affordable health care
- Safe housing
- Relationships with friends and family
“Each of these aspects affects the quality of life and the health of a patient,” Dr. Holman said. “Some standards of health we have to remember may not be possible if any of these five areas are less than ideal. If you live in an unsafe area and the only time you have to get in 30 minutes of exercise is late at night when it is dark out because you work long shifts to provide for your family, you may not be able to achieve that because it isn’t safe.”
Dr. Holman has seen and researched many different ways the social determinants of health can affect patients getting the care they need. Something seemingly as simple as the lack of a sheltered bus stop can be a big factor in patients not seeking medical care.
“We have heard from moms before that the reasons they cannot make it into their appointments were due to inclement weather,” she said. “If a new mom coming in for an appointment has no way of getting to it besides public transportation, if the bus stop isn’t covered there is no way they make it in that day. Think about it, I definitely wouldn’t want to stand in the pouring rain with my newborn to make it to an appointment.”
Not only can bus stops be a barrier but so can things like finding time to take off of work to go to an appointment and access to healthier food choices.
“It is unfortunately quite common for a patients to tell me that they cannot make it in for an appointment because their boss will not give them that much time to step away,” Dr. Holman said. “Pregnancy requires a lot of appointments to ensure the health of the mom and baby and the higher risk the pregnancy the more monitoring may be required.”
It is examples like these that are important to think about when considering action we can take as a hospital and as a community to make sure our patients receive the care they need.
Erica Hill, Director of finance & strategic initiatives for the LMH Health Foundation and director of equity, inclusion and diversity for LMH Health,said a study cited by the National Academy of Medicine found that medical care itself only accounted for 10–20 percent of the contributors to people’s health outcomes. By contrast, the social determinants of health play a much bigger role in influencing a person’s health, making up 80–90 percent of the contributing factors.
“LMH Health and the LMH Health Foundation are being intentional about advancing health equity and addressing social determinants of health,” Hill said. “Dr. Jabraan Pasha came to educate leadership, staff and providers on this very topic, in addition to implicit bias in health care. LMH Health is committed to helping people and our community be healthier by integrating social determinant factors with clinical care for a more holistic approach to health and well-being.”
LMH Health is committed to the inclusion of screening around the impact of social determinants of health, our partnership around food security with Just Food and engaging other community partners to address the social determinants of health and give patients the resources they need.
“Everyone should have the opportunity to be healthy,” Hill said. “The LMH Health Leadership Academy is another example of an upstream solution that provides an opportunity to high school students all while addressing/intersecting with the five domains of the social determinants of health.”
Community members can support work in social determinants of health by making a gift to the LMH Health Foundation.
“The Foundation’s Help and Healing fund provides financial support for patient care, regardless of a patient’s ability to pay,” Dr. Holman said. “The fund also supports transportation for patients who might not otherwise have access to care.”
Dr. Holman said that helping can be as simple as offering offer a friend, peer or family member a ride to their appointment. “If you can afford to watch someone’s kids or provide a meal, this can mean so much to someone as well. Providing food and diapers along with period products can be huge. Donations of time and necessary resources can make a huge difference.”
For the past few months, the team at Lawrence OB-GYN Specialists has implemented a social determinants of health screening tool which is given to patients during their appointments. The tool asks questions in the following 12 categories – housing, food, transportation, utilities, child care, employment, education, finances, personal safety, mental health, insurance and assistance. From June to October 2021, 393 patients have completed the form with financial and food concerns being at the top.
Additionally, LMH Health partners with Family Promise of Lawrence, a local nonprofit that helps families in the midst of a housing crisis achieve stabilization.
“It is important not to negate what someone is going through in their personal lives when it comes to missing appointments,” Dr. Holman said. “We need patients to have affordable housing, mental health care, a stable living environment and so much more to live a healthy lifestyle. I think the upward progression is happening, and our clinic and LMH Health as a whole will continue to work to break down the social determinants of health in any way we can.”