Exploring Social Determinants of Health

   Social determinants of health impact one’s physical and mental health outcomes, but are often not prioritized in traditional healthcare service delivery. Issues such as trauma, racism, access to adequate and safe housing, nutrition and so on are all factors that influence one’s overall health and well being. For many racial and ethnic minority groups, racism and barriers to healthcare are issues that significantly impact our communities and overall quality-of-life outcomes and risks. This collection of videos, explores social determinants of health, health disparities and interventions that help to promote better access to care and community-based health initiatives that consider intersectoral actions that can rectify these challenges.    

   After watching “What makes us get sick? Look upstream”, Rishi Manchanda explained the importance of moving beyond simply treating symptoms that a client presents but urges clinicians to see a patient from a holistic point of view to prevent recurrent visits to healthcare facilities and to improve treatment. I was inspired to hear about Manchanda’s support of the utilization of an upstream approach that moves beyond health  care systems simply treating symptoms, but urges clinicians to consider one’s environment, race, income, and other social determinants when delivering treatment and preventative services. Pondering factors like where an individual eats, sleep, lives, and works can better provide clinicians with perspectives on what treatment, resources, and services that a client may need for better health promotion. In this particular video, Rishi Manchanda explained how Veronica’s migraine pain was treated because she was able to resolve her mold problem after working with a community health worker. These types of interventions can help patients to not only manage pain with medication, but to identify problems in their environment that may adversely affect their health. Additionally, patients can have healthcare systems that provide linkages to resources that can improve issues at home, which can potentially enhance Veronica’s health and even her family’s life. Social Workers can help to bring these factors to surface when collaborating with doctors to ensure that client receives holistic care. In clinical settings, I believe integrated care and considering the patient environment can help to promote more effective approaches to assisting individuals and families to live healthier lives. 

    Racism and discrimination are also possible barriers that prevents people of color from receiving adequate access to healthcare and effective treatment. In the video, “How racism makes us sick”, David R. Williams confirms how racism, as a public health concern, impacts the health outcomes of black people. This is a reality that I am all too familiar with, however the development of the Everyday Discrimination Scale as an assessment tool used to determine how often black are discriminated against can help to provide health care providers with the quantifiable data that can monitor the impact of racism. This data can directly correlate with a broad range of diseases that people of color face. This information has prompted me to consider ways in which clinical tools can be modified to consider the experiences that people of color face. Many clinical assessment tools do not always ask patients about the trauma or stress that is linked to racism. This video encouraged me to think about the importance of developing clinical assessment tools and/or asking patients in our interactions about how they feel racism influences their daily lives, physical and/or mental health, or quality of healthcare services.

    How a person’s life experiences, and environment can negatively impact their health links well with the information shared in, “How childhood trauma affects health across a lifetime.”  Nadine Burke Harris directly calls for Adverse Childhood Experiences (ACE) screening that capture what traumatic experiences a child faces that is directly linked to adverse health outcomes. Discrimination, racism, and trauma are often interrelated and many people of color that live in impoverished communities are often prone to experience more traumatic events as a child. As a clinician, it is important to encourage ACE screening to promote better health outcomes and to be mindful of what health conditions or issues that may arise in a client’s future. Tracking susceptibility to disease by monitoring ACE scores can help to create a more innovate preventative care model. Increasing screenings for ACEs will help clinicians to be better informed on what the patient is facing. In my own clinical practices, it is important to encourage ACE screenings, so that social workers can link children to resources that will help them to live better lives and to better understand potential behavioral symptoms that may result from unresolved trauma.

    When considering social determinants of health, it is also important to think of potential solutions that can help to address barriers to care. In the video, “How barbershops can keep men healthy”, Joseph Ravenell explains how doctor’s offices are not always a place where black men feel safe. As a result of this, many black men do not go to the doctors unless they are sick. However, bringing health care to community settings can help to increase access to care for black people. In clinical settings, this knowledge can help clinicians to promote preventative care and to encourage clinicians to work to create safe and supportive spaces that help black people to feel heard, valued, and prioritized.  

    We live in a time where a global pandemic has further revealed healthcare disparities that have existed for decades. Although Coronavirus (COVID -19) has had a global impact, research reveals that the number of COVID cases and deaths confirms the disproportionate impact that this virus has on racial and ethnic minority groups (CDC, 2020). This has ignited a conversation that urges health care facilities and more specifically, healthcare providers to move beyond traditional medical practices of treating symptoms and to ask questions that help to determine one’s environment and social support systems. Emerging needs for contact tracers, local testing sites, and public health guidance has demanded a new response from healthcare systems and social workers to encourage approaches to care that take into consideration where a patients lives, their race/cultural background and lifestyle choices which in turn  impacts health outcomes. These videos resonated with me because they revealed why it is important for healthcare systems to be prepared to acknowledge the conditions that impact the health outcomes of racial and ethnic minority groups and how this issue is not solely due to lifestyle choices and genetics, but by other external factors.

As we think about solutions, we can encourage enhanced screening and clinical tools that incorporate additional factors  in triage ( income, housing, so on). The collection of videos confirmed the importance of healthcare, expanding to consider holistic approaches to care that include additional questions that screen for environmental concerns or barriers that may result in disparities in outcomes for specific groups.