Fostering a Culture of Equity: Through Social Determinants of Health
Health inequities exist among populations of diverse racial and ethnic backgrounds. Hospitalizations for ambulatory care sensitive conditions such as COPD, heart failure, diabetes and hypertension are far higher for the black population. Inequities also exist for black children, as evidenced by an admission rate for asthma more than four times that of white children.
Social determinants of health (SDOH) contribute to health inequities and can be categorized in six domains: economic stability, neighborhood and physical environment, education, food, community and social context, and the health care system. Social determinants contribute to at-risk behaviors, disease and injury. Behavioral (lifestyle) patterns and social circumstances account for 40% and 15%, respectively of the contributors to premature death.
Health care system determinants include health (insurance) coverage, provider availability, provider linguistic and cultural competency, and quality of care. Provider access is somewhat limited, whereas the quality of care among African Americans is worse in 42% of the 182 metrics measured in the National Healthcare Quality and Disparities Report, 2016. An estimated 10-15% of health systems have SDOH programs. Programs involve housing, employment, education, food security, social and community context, and transportation.
Multiple stakeholders play an important role in identifying effective ways to leverage SDOH programs and create meaningful change. These includes federal and state government agencies, public health entities, community and non-profit service organizations, and health insurance plans and providers. Every entity, including individuals and their families, can contribute to setting up a system that addresses the SDOH challenges in healthcare. Providers are essential partners in the SDOH journey, serving as the closest health-related connection to patients affected by one or more SDOH factors.
To successfully implement SDOH, providers need to foster a culture of equity and make it a priority. This requires strategic planning and resources throughout the organization. It also requires an equity champion, patient screening and other factors, as highlighted in the article.