Up to 90 percent of health outcomes are a result of social, behavioral and economic factors, according to new data published in JAMA Open Network. Increasing amounts of research show that screening for the five leading social determinants of health (SDOH)—food security, housing access, transportation issues, utility needs, and interpersonal violence— can greatly improve patient outcomes.
However, new data indicate 33 per cent of physician practices do not screen for any SDOH; only 16 per cent screen for all five of the key SDOH. Without necessities, patients may not be able to purchase, store, or take needed medications. Patients may also experience high levels of stress, anxiety, and fear, which make them less likely to pay attention to other health concerns.
For example, at Northwest Permanente—a network of 59 medical offices in Portland, OR—a 15-year-old female patient (“Jennifer”) visited the ER 34 times in an 18-month period. Diagnosed with Type 1 diabetes, the girl had developed major depression. Suicide attempts resulted in two ER visits; other visits were due to symptoms of uncontrolled sugars.
Rather than simply treating diabetes and depression, the medical team began digging deeper into Jennifer’s life. She had been missing school regularly. She lived with her brother and her mother, who speak only Spanish, and worked two jobs, keeping her away from home most of the time. Their apartment had holes in the floor, and mold and mildew in many corners, says Imelda Dacones, M.D., president and CEO at Northwest Permanente, P.C.
Northwest Permanente connected Jennifer with a social worker who subsequently linked her and her family with a Latina community health worker. Through that community health worker, the family found better, more affordable housing and applied for financial assistance. With increased financial stability, Jennifer’s mom no longer needed to be away from home as often. After building trust with authorities, Jennifer agreed to start seeing a mental health therapist and to follow up more regularly with her doctor. She got control of her diabetes and mental health, graduated from high school, and is now in college considering a job in healthcare.
“Jennifer’s main issues were not her depression and diabetes,” Dacones says. “Her medical diagnoses—just as for all of us—do not define who she is. Screening for and helping to address the things most important to our lives empower us, ultimately, to own our total health. If we had only addressed her diabetes and depression through a ‘medical lens,’ I don’t know where she’d be today.”
Jennifer’s story exemplifies the importance of social determinants of health (SDOH), and how medical providers can help improve health outcomes by taking note of the non-medical factors that may be affecting patients’ health.
Continue reading on page 2...