Where They “Play” Can Affect Their Health
Knowing where your patients “play” can affect how you will approach their care and may have an impact on their health outcomes.
One important aspect of providing the best care is being aware of and screening for social determinants of health (SDOH). These determinants do not only influence the health of adult patients, but it also affects their children as well.
Social determinants of health (SDOH) affect the quality of life (QoL), health outcomes, and risks. We all are aware that poverty can limit access to care and education can be a predictor of health outcomes. SDOH is defined by Healthpeople.gov as — “conditions in the environment or setting in which people are born, live, learn, work, play, worship, and age”—. Social, economic, and physical conditions have an impact on health.
To understand SDOH, we have to understand the relationship between how a population experiences “place” and the impact of “place” on health. Schools, churches, and neighborhoods are places or environments in which individuals live. Where individuals live has an impression on their social engagement, sense of security, and well-being.
“Geography is destiny: the care one receives depends in large part on the supply of resources available in the place where one lives — and on the practice patterns of locality physicians.”- John E. Wennberg, M.D., M.P.H.
Five Key Areas of SDOH
There are five key areas of SDOH that display the underlying social issues. The five key areas are economic stability, education, social and community context, health and healthcare, neighborhood and built environment.
Addressing SDOH in Pediatric Patients
As healthcare providers, our main goal is to improve population health through a patient-centered approach. We cannot focus on providing care without first addressing the underlying issues. Being unaware of these determinants is the greatest concern, especially in our pediatric population.
Pediatric patients face the same disparities as adult patients: poverty, unequal access to care and education, insufficient environmental conditions, and lack of foods that support a healthy diet. Poor and minority children bear more health problems with less access to resources compared to children of higher socioeconomic status. A higher incidence of health problems increases the number of school absences, consequently affecting achievement. Education level is a critical determinant of social status and health. Individuals that do not obtain a high school diploma have a shorter life span and cannot provide better circumstances for their children — creating a cycle.
A webinar titled “Putting the Ethical Guidelines for the Use of SDOH Into Practice” was presented during a healthcare web summit in 2019. Speakers Jennifer Covich Bordenick, Karin VanZant, and Erin Benson discussed the overview of guiding principles, what the industry views as appropriate use of SDOH, and how SDOH can and should be leveraged to help patients achieve optimal health outcomes and wellness.
So, How Do We Break The Cycle?
A personalized care plan could improve care and QoL by pairing medical care and SDOH. How do we formulate a personalized care plan?
— Work with an interdisciplinary team.
— Identify patients with social determinants of health and assess their needs.
— Screen through analytics tools/data available.
— Identify gaps in community resources (i.e. food banks).
— Offer holistic care.
— Monitor the impact of the services and interventions on health outcomes.
Additionally, a care plan involves a customized intervention. The intervention is devised by educating patients, caregivers, or guardians on how their social determinants impact their health, reviewing different treatment options that may be available, and coming to an agreement.
Barriers
The biggest barrier currently being faced is screening or the lack thereof in the pediatric setting. This may be a result of fear of having those conversations with parents or caregivers, not fully understanding the impact of social determinants on the pediatric population, or the absence of a uniform screening tool. A study published in the Journal of The American Academy of Pediatrics systematically reviewed SDOH screening tools used with children, examined their psychometric properties, and evaluated how these tools detect early indicators of risk and inform care. The study concluded that the extent to which SDOH screening accurately assessed a child’s SDOH was largely unevaluated; suggesting that screening is being done in pediatric patients, but it is not being done as often or accurately.
Conclusion
Social determinants of health affect an individual’s health and QoL. Pediatric patients face social determinants unknowingly, so it's an important conversation to have with parents or caregivers no matter how difficult that may be. Addressing these concerns will ultimately help providers choose which direction they will start from when putting together a personalized care plan. Therefore, knowing where your patients play, live, learn, and age can have an impact on their health outcomes.
References
- Social Determinants of Health. Healthy People 2020. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health#five. Accessed April 5, 2020.
- Wennberg JE, Bubolz TA, Fisher ES, et al. The Dartmouth Atlas of Health Care in the United States. AHA;1996
- Put the Ethical Guidelines for the Use of SDOH into practice [Video]. YouTube. https://www.youtube.com/watch?time_continue=507&v=7pjh99-n3fM&feature=emb_logo. Published July 15, 2014. Accessed April 6, 2020.
- Healthcare Websummit. Putting the ethical guidelines for the Use of SDOH into Practice. Available at: https://www.healthwebsummit.com/lexis081419.htm. Accessed April 6, 2020.
