Anesthesia is typically perceived to be far downstream in #healthcare. Appearances might appear equal upon entering the operating theatre. Each individual appears indistinguishable with their disposable booties, hat and unfashionable Johnny-shirt. They enter a rather drab and cold operating theatre with its large table at the centre. Very little distinguishes each patient once they pass through these doors.

Who are the patients you see each and every day in the operating room or in the preoperative clinic or in the pain clinic. What advantages or disadvantages did they face in their life. How different or how similar to you and your family are they? What resources are missing in their lives?

During a preoperative history these are some of the questions I have begun to ask myself…but I have never asked my patients about their socioeconomic status or other measures of ‘status’ from a population health perspective…does this matter to an anesthesiologist – should it? Something as simple as a postal code may make a difference.

The social determinants of health #SDoH are the social conditions influencing the differences in health status. The distribution of health-damaging experiences is not in any sense ‘natural’ but the result of poor social policies, unfair economic arrangements and bad politics. Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. World Health Organization. ISBN 978–92–4–156370–3. Are there opportunities in the practice of anesthesia to address the #SDoH and their potential impact?

Social determinants of health is not just rooted in primary care. Could inclusion of a few #SDoH directed questions in the preoperative assessment allow us to deliver better care to disadvantaged patients — food for thought. Could we plan for cost effective postoperative analgesia, identify necessary social work consultations, identify barriers to ERAS, and/or ensure access equity to anesthesia services. What else am I missing — tweet it out #UpstreamAnesthesia