Every day, patients' health is affected – for better or for worse – by factors like income, education, access to fresh food, access to green space, or access to a safe living space and neighborhood. Health care professionals witness how these aspects of a person's day-to-day living environment, together known as the social determinants of health (SDOH), influence the arc of a person's life, starting in childhood.

Clinicians also see how negative SDOH like poverty and racism contribute to disparities in health care outcomes. For instance, in the U.S., Black and Hispanic patients experience higher rates of many adverse surgery-related safety events relative to White patients at hospitals across all safety grades, as shown by data looking at racial, ethnic and payer disparities in terms of adverse safety events across Leapfrog Hospital Safety Grades.

Fortunately, clinicians and organizations can craft more effective and equitable care interventions by elevating their awareness of key aspects of SDOH.

For individual clinicians, this heightened awareness coalesces into the provision of more holistic care. Organizations can also commit to collaboration, outreach and advocacy for measures that make a dent, not only in individual patients' care experiences and health outcomes, but in the root causes of SDOH.

Interconnectedness

"Social determinants of health are not isolated variables," says Shelise Valentine, RNC, MSN, director of Clinical Education, Healthcare Risk Advisors, part of TDC Group. "They are interconnected and often influence each other. For instance, income can affect access to education, nutritious food, health care services, and quality housing. Similarly, education can influence job opportunities and income."

These intersections create a complex web of social factors that together shape an individual's health. Acknowledging these connections is vital for effectively addressing health disparities.

Health Disparities

SDOH are significant contributors to health disparities, which are avoidable and unjust differences in health outcomes between different population groups. For instance, relative to White patients, Black and Indigenous patients are two- to three-times as likely to die from complications related to pregnancy. These disparities often mirror societal inequities, thus efforts to reduce health disparities must consider the broad spectrum of social determinants, from economic factors to cultural norms and environmental conditions.

Health care professionals are ready to engage in this effort, says Elizabeth Y. Healy, vice president of Government and Community Relations for The Doctors Company, part of TDC Group. Yet in the face of such broad systemic issues, "What they don't always understand is what they could or should do, specifically, to support equitable care and treatment in the face of inequitable wider conditions." For many health care professionals, getting a grip on SDOH feels overwhelming.

Holistic Care

By evaluating social determinants, practitioners can offer care that is centered on the patient and considers the wider context of their lives, which is commonly described as holistic care.

Reflective listening forms the foundation. In spite of best intentions, relationship building-blocks can get short shrift when health care practitioners are rushed by throughput expectations – it can feel like there's no time to hear the patient's story. Click here to learn steps for reflective listening.

Bridget O. Howard, DNP, CNM, FACNM, manager for Advanced Practice Providers in Women's Health at the Hospital of the University of Pennsylvania and a member of TDC Group's APC Advisory Board, emphasizes that health care professionals need "the time to ask the difficult questions" for their conversations to encompass SDOH, not to mention training that empowers them to be "comfortable with asking those questions."

This is where organizational support comes in:

• How care teams are structured affects practitioners' ability to form relationships with patients, which affects their ability to provide holistic care. Team-based care models can promote the formation of stronger patient relationships. Further, health care systems that have more closely integrated social workers into care teams have found that social workers can assist with assessing food insecurity, filling transportation gaps, and other SDOH-related patient needs that clinicians see every day.
• Some organizations are directly addressing shared local SDOH. For instance, health care systems operating where grocery stores are distant have begun locating nutrition-focused markets on-site. Some even offer healthy-cooking classes. Others may partner with a local food bank or food pantry to offer food on-site to patients who struggle to afford it, says Howard.

Policy Changes

Policy-driven efforts to address SDOH are designed to, over time, encourage access to care, which helps to gradually erode certain disparities.

• The Joint Commission, a widely recognized independent accrediting body for health care organizations in the U.S., in 2023 introduced new requirements to address health care disparities. These include the collection of patient race and ethnicity information and prohibiting discrimination.
• The Centers for Medicare and Medicaid Services' (CMS') 2023 final rule focuses attention on SDOH, and the CMS Framework for Health Equity 2022–2032 addresses priorities like expanding the collection and reporting of equity-related data, addressing causes of disparities within CMS programs, and building the capacity of health care organizations to reduce disparities in care and outcomes.

In many organizations, nurses' everyday workflows may already align with some new policy requirements. For instance, nurses are accustomed to asking patients questions regarding their lifestyle, stress level, diet, alcohol consumption, physical activity, etc. Therefore, health care organizations and systems can incorporate questions that screen for SDOH such as food insecurity.

For instance: "How hard is it for you to afford and access the very basics like food, housing and medical care?" These sorts of screening questions assist nurses in caring for patients – and help organizations better understand the needs of their patient populations.

Practitioner Advocacy

Many clinicians are ready to address the root causes of care disparities as they connect to SDOH. Valentine, an experienced provider of safety education for labor and delivery teams with substantial experience in the emergency department, describes adverse SDOH and interventions that address them in terms of a kettle on a hot stove: "You hear the kettle and it's screaming. You can take the top off the kettle, but the fire's still going, right? We need to turn that fire off."

With that in mind, health care practitioners can advocate for their organizations to participate in proven programs that address SDOH. One example is the HealthySteps program, which supports parents who have experienced childhood trauma in managing their stressors and providing secure attachment to their kids. The Montefiore Health System and others are inviting parents of their pediatric patients to enroll.

Informed health care practitioners can advocate for policy changes, contribute to community outreach efforts, and collaborate with interdisciplinary teams and community organizations to address social determinants and promote health equity. Howard says, "We're at the health department in Philadelphia. We're advocating and getting in the mayor's office. We are at the state level, and we're at national levels … We're comparing notes with colleagues who sit on national boards."

Through conversations that cross regions, roles and specialties, health care professionals are relaying insights "either down to our teams or up to our administration. Both of those directions are needed to ensure we've got the best outcomes for our patients."

Comprehending SDOH entails understanding their interconnected dynamics, identifying their part in propagating health disparities, recognizing the pivotal function of health care professionals in managing these factors, keeping up with the most recent regulatory modifications, and appreciating the significance of holistic care. Individuals can encourage their institutions to participate in productive efforts.

For instance, TDC Group's community investment program is centered around addressing SDOH, including health equity and access to care. Click here to learn more about this program.

Together, these insights can help guide more effective and equitable health interventions, ultimately contributing to improved population health and well-being.

Clinical Topics: Cardiovascular Care Team

Keywords: Cardiology Magazine, ACC Publications, Social Determinants of Health, Economic Factors, Poverty, Racism, Food Insecurity, Health Services Accessibility