Pearl S. Buck, Pulitzer and Noble Prize-winning novelist, said “The test of a civilization is in the way that it cares for its helpless members.”
How we care for those in need, in part defines who we are as a nation. At the heart of why health care exists is the desire and necessity to treat those that are suffering and ill. A health care facility or provider is judged by their ability to treat a person; identify the health problem, the causation, create a treatment plan and support the person in addressing their health needs.
Since the social determinants of health (SDoH) movement has gained momentum in health care, we see a stronger drive to address not only the physical and mental health of people, but to take a more active role in identifying and treating and person’s socioeconomic and psychosocial well-being.
As a nation we have recognized food, water, shelter and clothing are basic human needs. According to the Census Bureau, more than 37 million Americans were living in poverty in 2020. Alongside the spread of the COVID-19 pandemic, we saw the spread of economic and social disparities; our communities were impacted by both a health and a socioeconomic crisis. Our health is interconnected with our physical environment, our access to resources and our economic stability. These issues are compounded by institutional racism, lack of sanitation, poor education, inequity and overall marginalization of people and communities.
SDoH is often described as the conditions in the places where people live, learn, work and play, that have an impact on health outcomes. People do not choose where they are born, the conditions they grow up in, the educational system they are provided, the amount of food they can access, the significance of the racism they may face, etc.
When we are born into adverse circumstances, we begin life at a disadvantage. While some can grow and thrive, others fight for survival. The idea of SDoH grew from these deep-rooted issues. Problems around poverty, racism, housing, food insecurity, health care access and many more are not just issues for the person experiencing them, but complex social issues that are built into our systems. When we start to recognize that these problems are not just the problems of the individual facing them, we start to gain traction in creating large scale change by developing systematic approaches to alleviate both institutional and personal problems.
Health care takes proactive approaches to ensure the health of people through wide reaching and scalable treatments, education and research. Through SDoH we see health care taking on a role and responsibility where social and environmental elements intersect with our health.
In many ways it is natural that health care systems become a stakeholder in SDoH. Collaboration between government, health care, communities and individuals is key to whether we successfully address SDoH. When the COVID-19 pandemic hit, we witnessed the global impact to the health and well-being of people and in response we saw national and global responses. However, when we realized that we have a social, environmental and economic crisis … well, our response has not been as great as the need.
Health care systems, communities, organizations and governing bodies around the nation acknowledge that by identifying and participating in addressing SDoH, the overall health and well-being of individuals can improve. It will take a team and collaborative efforts at all levels.
As we look to our next steps, we must remember that we are all connected, and the only way forward is to ensure that every person, community, organization and system is just as strong as the rest. In the wisdom of Maya Angelou: “If it is true that a chain is only as strong as its weakest link, isn’t it also true a society is only as healthy as its sickest citizen and only as wealthy as its most deprived?”
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