ACP: Shifting Focus to Social Determinants of Health Can Improve Patient Care

The American College of Physicians (ACP) has published a set of recommendations aimed at improving patient care and health outcomes by better integrating social determinants of health into the healthcare system.¹

“This is your zip code, not your gene code,” said Jack Ende, MD, president of the ACP, at a press briefing at the Internal Medicine Meeting 2018, held April 19-21 in New Orleans, Louisiana. “This is where you live, how you grew up, your environment, the level of food security that that you have, the level of emotional security that you have at home, economic status, and the like. We now really do understand that these can be very influential in health and healthcare outcomes.”

Sarah Candler, MD, MPH, of the Michael E. DeBakey VA Medical Center, echoed these sentiments.

“All over America, doctors and healthcare teams work hard to make sure that all patients are healthy. But sometimes our toolbox of medicines and skills don’t get us there,” said Dr Candler. “The reason is often these social determinants of health — things that contribute to where we live, learn, work, and play. Sometimes we need to look outside of our clinical space to figure out how to make sure all of our patients have opportunities to be healthy.”

Health disparities are often rooted in social, economic, and environmental factors. On average, there is a 15-year difference in life expectancy between the most advantaged and disadvantaged US citizens.²

“Taking a closer look at social determinants of health can help us better understand and address the social factors that have an impact on patient health,” said Dr Ende in an ACP press release.³ “It’s important that physicians and other medical professionals recognize and account for social determinants of health to create a more comprehensive approach with our patients. Moreover, such an approach can help to eliminate significant health inequalities often associated with social determinants of health, such as homelessness, food insecurity, and mental health stressors such as domestic violence or social isolation.”

The authors of the position paper¹ reviewed studies, reports, and surveys on social determinants of health to determine ways in which physicians, policymakers, communities, and individuals can help to close the gap on health disparities. Their recommendations include incorporating social determinants of health awareness into medical education at all levels and increasing research into the causes and effects of these nonmedical factors.

In addition, the ACP also supports public policies that address “downstream environmental, geographical, occupational, educational, and nutritional social determinants of health.”¹

“A greater focus on social determinants of health can enable physicians to become stronger advocates for patients and help reduce negative health outcomes that are often associated with social determinants of health,” said Dr Ende.³

Inequities in power and race must also be more closely examined to determine health inequities. In an accompanying editorial published in Annals of Internal Medicine,⁴ David U. Himmelstein, MD, and Steffie Woolhandler, MD, MPH, of the City University of New York at Hunter College and Harvard Medical School, explained the importance of not overlooking factors that directly affect minority populations, such as overly aggressive policing and mass incarceration. Incarceration, for example, can have a negative impact on economic success, voting rights, and long-term health. These effects not only affect the person behind bars but also the person’s family. Mobilizing against racism is necessary to end the physical toll of oppression.

“Physicians’ voices carry great weight when we speak selflessly on behalf of patients,” wrote Drs Himmelstein and Woolhandler. “Our profession must act forcefully with hope and courage.”

References

1. Daniel H, Bornstein SS, Kane GC; for the Health and Public Policy Committee of the American College of Physicians. Addressing social determinants to improve patient care and promote health equity: an American College of Physicians position paper. Ann Intern Med. 2018;168(8):577-578.
2. Chetty R, Stepner M, Abraham S, et al. The association between income and life expectancy in the United States, 2001–2014. JAMA. 2016;315:1750-1766. doi:10.1001/jama.2016.4226
3. Internists say social determinants of health play role in improving patient care and promoting health equity [news release]. Washington, DC: American College of Physicians. https://www.acponline.org/acp-newsroom/internists-say-social-determinants-of-health-play-role-in-improving-patient-care-and-promoting. Published April 17, 2018. Accessed April 24, 2018.
4. Himmelstein DU, Woolhandler S. Determined action needed on social determinants. Ann Intern Med. 2018;168(8):596-597.