Berks County Medical Society Medical Record Fall 2018 - 16

Health Determinants Beyond the Exam Room
continued from page 15
Additionally, food insecurity and limited food options are major
factors driving high obesity rates and a hurdle in achieving medical
compliancy. This problem is especially prevalent in the City of
Reading, which is considered a "food desert" and has a high rate of
poverty. Without access to fresh, affordable produce, many families
turn to processed goods, which are nutritionally unsound and a
major factor in developing pre-diabetes. Food insecurity also plays a
role in medication compliancy due to financial factors. When faced
with the choice of putting food on the table or buying prescriptions,
patients tend to opt for food.
Together, transportation and food insecurity are directly tied to
the major medical concerns facing Berks County as identified by
the Community Health Needs Assessment; obesity, diabetes, mental
health disorders and substance abuse. Social barriers in combination
with low-socioeconomic status increase the burden of these medical
conditions for those most at risk for chronic illness.
In sum, social determinants of health have a tremendous impact
on an individual's health. As health care providers, physicians focus
on treating illness and improving lives with medicine. However,
the line between purely medical and social factors in an individual's
overall health is blurry. Social determinants have traditionally
been regarded as factors outside the realm of medicine, but recent
evidence-based research has painted a clear link of these factors to
health outcomes.
Health is a human right. In the constitution of The World Health
Organization, it states that, "The enjoyment of the highest attainable
standard of health is one of the fundamental rights of every human
being without distinction of race, religion, political belief, economic
or social condition." It is not enough to just treat disease. Physicians
need to address the social, political, and environmental context of
illness to provide the best care possible for patients.
In recognition that the present health care model is not
providing value for money and that the present trajectory of costs is
unsustainable, at the institution level health systems have begun to
address social determinants of health. As the paradigm shift in how
payors reimburse providers of health care continues to emphasize
population outcomes over volume of services provided, responsibility
to address social determinants will increasingly be shared by
physicians.
Despite the current constraints and limitations of the health care
system, physicians can lead interventions at the patient and practice
level to address social determinants. At both levels, interventions
should be directed to remove barriers to accessing health care and
improve patient medical experiences in order to promote health
equity.
At the patient level, physicians can address disparities caused by
social determinants by becoming more aware of the social factors
in a patient's medical history and improving the general patient
experience. Recommended suggestions include...
* Implementing universal screening for social determinants of
health prior to examination

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* Asking patients about social challenges in a sensitive and caring
way
* Referring patients and helping them access benefits and support
services
* Incorporate culture-specific attitudes and values into health
promotion tools
* Include family and community members in health care decision
making
At the practice level, physicians can advocate for structural
changes in how care is provided to better support the needs and
eliminate the barriers faced by patients. Recommendations include...
* Improving access and quality of care for hard-to-reach patient
groups
* Integrating patient social support navigators into the primary
care team
* Recruit and retain minority staff
* Provide linguistic competency that extends beyond the clinical
encounter to the appointment desk, advice lines, medical billing,
and other written materials
* Provide training to increase cultural awareness, knowledge, and
skills
"The burden of social determinants lies on the entire health care
system. We need doctors to come to the table."
-Desha Dickson

Works Cited:
Artiga, S., & Hinton, E. (2018). Beyond Health Care: The Role of
Social Determinants in Promoting Health and Health Equity. Retrieved
from https://www.kff.org/disparities-policy/issue-brief/beyond-health-carethe-role-of-social-determinants-in-promoting-health-and-health-equity/
Brody, G. H., Yu, T., Chen, E., Miller, G. E., Kogan, S. M., & Beach,
S. R. H. (2013). Is Resilience Only Skin Deep? Rural African Americans'
Preadolescent Socioeconomic Status-Related
Risk and Competence and Age 19 Psychological Adjustment and
Allostatic Load. Psychological Science, 24(7): 1285-1293.
Brach, C., & Fraserirector, I. (2000). Can Cultural Competency Reduce
Racial And Ethnic Health Disparities? A Review And Conceptual
Model. Medical Care Research and Review: MCRR, 57(Suppl 1):
181-217.
Hamilton, B. E., Martin, J. A., & Osterman, M. J. (2016). Births:
Preliminary Data for 2015. Natl Vital Stat Rep, 65(3): 1-15.
Health and Human Services (2014). Infant mortality disparities fact
sheets. Retrieved from http://minorityhealth.hhs.gov/omh/content.
aspx?ID=6907&lvl=3&lvlID=8.


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Berks County Medical Society Medical Record Fall 2018

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