The importance of social determinants of health
My first job as a nurse was in the progressive care unit, often caring for patients with chronic conditions like COPD, CHF, and diabetes. There was much to learn as a new nurse, but it didn’t take me long to recognize repeat patients. They had just been discharged a few weeks or days before in stable condition with a plan for follow-up appointments, new medicines, and dietary changes. On their second admission, it would surface that they didn’t go see the specialist, fill their new prescriptions, or change their eating habits. The readmissions were frustrating for the patients and baffling for the healthcare team. Why didn’t the patients follow our instructions?
I had a lightbulb moment years later when I was introduced to the concept of social determinants of health (SDOH): the non-medical factors that influence a person’s health outcomes.4 SDOH encompass things like income, employment, transportation, housing, social support, racism, education, and access to healthcare.1, 2, 3 Studies estimate that SDOH account for up to 80% of health outcomes.5
I thought back to the repeat patients. I understood that their lack of follow-through wasn’t intentional and that my viewpoint was biased because of my privilege. It made sense that a patient with a fixed income couldn’t afford an expensive inhaler. It made sense that a person in our rural community who didn’t own a car couldn’t get to a specialist appointment 30 miles away. It made sense that someone with access to only a dollar store wouldn’t be able to buy fresh foods. Seeing patients’ lives through the lens of SDOH helped me realize how little the healthcare system confronted the upstream causes of illness. Could the patients’ medical situations have turned out differently if our team was equipped to assess and address SDOH?
New tools to ease SDOH discussions with patients
Krames understands the significant impact SDOH has on patient outcomes. Our patient education has always been attentive to health literacy, one type of social determinant. Now, Krames has developed more resources around SDOH to support both clinicians and patients.
First, we developed a clinician-facing sheet (available Q3 2022) that gives a brief overview of SDOH and suggests how to discuss SDOH with patients. These can be sensitive topics, so approach these discussions with care. We understand that clinicians are busier than ever, so the sheet is concise. We also developed a resource sheet that lists organizations where patients can get assistance. A clinician could refer to this sheet or give it to a patient. The list can be customized to include your local community organizations.
Our hope is that these resources equip you to holistically care for patients, save you time by gathering resources in a central place, and ultimately improve patients’ health outcomes.
- Social Determinants of Health. U.S. Department of Health and Human Services Web site. https://health.gov/healthypeople/priority-areas/social-determinants-health. Accessed April 28, 2022.
- About Social Determinants of Health (SDOH). CDC Web site. https://www.cdc.gov/socialdeterminants/about.html. Accessed April 28, 2022.
- Artiga S and Hinton E. Beyond Health Care: The Role of Social Determinants in Promoting
- Health and Health Equity. https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/. May 10, 2018. Accessed April 28, 2022.
- Social determinants of health. WHO Web site. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1. Accessed April 28, 2022.