I chose two articles to summarize social determinants of health (SDOH). The first, Determinants of Health: What’s a Healthcare System to Do? by Gottlieb et al. talks about the impacts SDOH have on health care systems and how systems need to be adaptive and meet the changing needs of society. Their description of SDOH resonated with me.
how individuals’ genetic and behavioral risks operate in the context of social, political,
and environmental conditions that alter access to resources such as healthy food,
safety, financial resources, quality education, and gainful employment— all of which
shape health outcomes over the life course. (Gottlieb et al., 2019)
I wanted to probe further into the impacts of SHOD on the health care system and found myself searching for literature on adverse childhood experiences (ACE) scores and their impact on SDOH over time. ACE is the overarching phrase for repetitive events happening before age 18 causing stress in children and can include abuse (psychological, emotional, physical, and sexual) household substance abuse, mental illness, domestic violence, or criminal behavior. It also includes physical and emotional neglect, witnessing abuse to others, community violence or having an incarcerated family member. (Alhowaymel et al., 2023)
Knowing that ACE may lead to allostatic load and result in cardiovascular, endocrine, and immune dysfunction and there is an evidence-based relationship between ACE and diabetes, depression, anxiety, mental disorders and obesity. (Alhowaymel et al., 2023) This knowledge supports the need for the complimentary health care action strategies put forward by Gottlieb et al. that include modifying patient care and influencing at wider community levels. Hospital and facility programming and supports are only effective if people come in to access them. By increasing health care funding for community and social supports trained multidisciplinary professionals ca
n have a greater reach, accessing and providing supports and treatment to people that would not have, either by choice or circumstances, accessed in facility supports.
If reducing ACE scores leads to evidential decrease is disease progression this alone should be enough to support funding for wider community support to address SDOH. With a political shift in how health care is funded- away from treating disease to one of supporting health with affordable access to food, housing, education and employment there can be positive impacts on SDOH which proven in these articles has a direct correlation to disease progression.
References
Alhowaymel FM, Kalmakis KA, Chiodo LM, Kent NM, Almuneef M. Adverse Childhood Experiences and Chronic Diseases: Identifying a Cut-Point for ACE Scores. Int J Environ Res Public Health. 2023 Jan 16;20(2):1651. doi: 10.3390/ijerph20021651. PMID: 36674405; PMCID: PMC9863315.
Gottlieb, Laura MD; Fichtenberg, Caroline PhD; Alderwick, Hugh; Adler, Nancy PhD. Social Determinants of Health: What’s a Healthcare System to Do?. Journal of Healthcare Management 64(4):p 243-257, July-August 2019. | DOI: 10.1097/JHM-D-18-00160
Comments