While I try to share new ideas in this blog, some topics demand revisiting. The Social Determinants of Health is one of them. Each word tells a story: Social. Determinants. Health. Their intersection is undeniable, and slowly but surely, the primary care community is getting on board with a concept that the public health community has been grappling with for decades. First, a quick review: social determinants of health may include:
- Economic resources, including access to jobs that provide a living wage
- Safe workplaces and safe neighborhoods
- Quality of schools and availability for advanced education and training
- Clean and safe water, air and food
- Positive support systems through home and family relationships and extended social interactions
One of our organization’s embedded care managers, a pharmacist, recently encountered a patient who was not taking her medications as prescribed. The issue wasn’t the medication, per se. It was the fact that the patient had no money for food (“do not take on an empty stomach) or rent (should I pay for shelter or medication?) Within 24 hours, this patient had access to groceries and rent assistance. A Band-Aid? Perhaps for now, but the lesson is the care manager understood that it was the social determinants of this patient’s health that impeded her ability to manage her condition. It wasn’t the medical care or treatment plan.
I’ll let you in on my secret professional crush. His name is Rishi Manchanda, MD and he’s a primary care physician and public health innovator who has worked in South Central Los Angeles. Dr. Manchanda has a powerful Ted Talk out (it’s from 2014 but still timely) where he explores the role that social determinants of health play with patients who are low income. (I think my staff has memorized the video, considering how many times I’ve shared it at company meetings and member events. Still, they appreciate it – and indulge me.)
“Home is where health – and often, illness – begins.” So says Dr. Manchanda, noting that zip codes may matter more than genetic codes in determining one’s health and wellness. Dr. Manchanda calls for more “upstreamists” in the healthcare community to increase efforts to examine the social determinants of health. These upstreamists don’t treat the symptoms; rather, they investigate and aim to resolve the root cause of illness or lingering ill health. They are generally not physicians, but clinicians, social workers, public health experts and even public interest attorneys. Whatever their professional designation, we need more of them.
“It’s a system issue, not a healthcare issue,” and upstreamists can help change the system, while also unburdening the PCPs through engagement of the broader community. In Michigan, we need a call to action to engage these current and would-be upstreamists. To that end, I’m planning a workshop in Southeast Michigan in spring 2018 to help identify, educate and encourage upstreamists in our home state. Date and details are to be determined, but partners and sponsors will be sought to help take on this major endeavor. Are you game? Please reach out to me at firstname.lastname@example.org. With leadership in initiatives like the Patient-Centered-Medical-Home and strong higher education programs in social work, public health and other complementary academic disciplines, we Michiganders can swim upstream with the best of them. Oh, and I don’t want to jump the gun, but I’ve invited Dr. Manchanda to join us and he expressed interest in an initial email exchange. Stay tuned.