Health Policy globally needs redesign to include “social determinants of health” There is a need to reorganize care around achieving value for patients. In order to improve health outcomes for patients, we first need to define all the activities that are likely to enhance health for specific segments of the population. Health care redesign should essentially include into clinical settings the activities that will influence the social factors (address social needs, such as a lack of housing or access to adequate food) that are intertwined with health. How important it is for clinicians to associate personnel with expertise in social determinants of health to support patients?
Syed - health policy should always include 'social determinants of health' otherwise it is not health policy. Clinicians, and especially medical practitioners (although nurses, my discipline, can be equally culpable) are often the people least likely to focus on or consider social health determinants within their daily practice. They are far more likely to focus on acute, disease/illness-orientated 'risk' outcomes over 're-focusng upstream' priorities. The Ottawa charter has long sought to 'reorientate health services' away from this biomedical model, towards a social model based on determinants of health, but the change has been extremely slow, insidious and, in many cases, no change at all.
It is critical to engage expertise in social determinants of health policy because in my opinion health care service itself is more a social problem than a clinical problem. it is more a society's problem than a clinician problem, in terms of burden and decision making in a way that lessens the burden. Many admissions at hospitals could be avoided if questions pertaining to the individual's socio-economic context were adequately addressed. Addressing such concerns requires a detail appreciation of the social determinants of health, so that a lot of the clinician's burden can be reduced if health policy recognizes and incorporates expertise in social determinants of health. Many patients go to hospitals because of low incomes, social exclusion, poor housing and indeed fewer economic opportunities in life. Most communicable diseases have closer ties to the socio-economic situation of the individual than scientific explanations. The fact a disease like cholera is still a burden for developing countries and yet a forgotten issue in countries in the developed world; and the current difficulty the world faces in dealing with ebola due largely to social context in which the epidemic is being managed says it all.
Population health is founded on social determinants of health, the problem relates to the transfer of knowledge to enable the health care workforce to understand the economic, political environment and social parameters contributing to the overall health of a community. This require integrating courses across all medical, nursing and allied-health professions related to social determinants. Public health graduates and the clinician have a clear understanding of the epidemiological factors contributing to disease prevalence, however the X-ray technician may not understand the link between social determinants and population health. My research focused on the prevalence of breast cancer in young AA women it has been clearly concluded that regardless of age mortality rates are higher in ethnic women; therefore addressing the factors contributing to the lack of access to health, lack of health insurance, belief systems must be transferred from the clinician to ancillary personnel.
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