Sociopolitics and the social determinants of health: you can’t have one without the other

Whether or not you want to “get political”, if you work in the healthcare space, you can’t run, hide, or bury your head in the sand (trust me, I’ve tried), because the truth is, there is a seemingly inextricable link between politics and healthcare.

Despite my lack of comfortability even typing the word p-o-l-i-t-i-c-s in an opinion piece that is published on the web, I feel compelled to share my views on the topic given a recent encounter with a rather influential figure in the healthcare community. This individual, someone I’d say I admire, replied in response to a message I had sent them about the role the social determinants of health (SDoH) play in creating health equity for marginalized communities, “if you’re interested in talking about the SDoH, make sure the message is about how to achieve better patient health outcomes from a healthcare perspective not a political one”.

This remark left quite an impression and for the past month has created an internal debate: is that even possible?

In this article, I question the following: is it ironic that sociopolitical activism (e.g. LGBTQ+ rights, immigration reform, etc.) is burgeoning at the same time discussions around the importance of the SDoH are trending? Conversely, does the simultaneous growth of sociopolitical activism and the importance of SDoH in improving health outcomes further support the idea that whether or not you are interested in politics, politics enters the healthcare space at all levels – even as granular as the clinician-patient interaction?
The relationship between SDoH and patient health outcomes

First, it’s important to ensure there is common understanding of what is meant by patient health outcomes as there are a variety of definitions used. For the purposes of this article, I will use The World Health Organization’s view that “an outcome measure is a change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions. Outcome measures (mortality, readmission to the hospital, patient experience, etc.) are the quality and cost targets healthcare organizations are trying to improve”.

As noted above, meeting care quality and cost goals are critical to the sustainability of the healthcare system itself. A concept that is by no means new, but is gaining a lot of popularity in the healthcare community, is the importance of incorporating the patient’s SDoH into the clinician’s decision making process (e.g. formulating a diagnosis, recommending a treatment plan, etc.) as the SDoH are the key to enabling better health outcomes for patients. For instance, a quick Google keyword search on “the importance of the SDoH” will produce countless publications, from medical journals, media outlets and health focused organizations like Healthcare IT News and Health Data Management, affirming this belief.

It’s important to understand that the key to systematically and successfully incorporating the SDoH into clinical decision making is building an effective data lifecycle. I want to emphasize this is one hell of a lot of data! For instance, the CDC put together a short list of tools and data sources to reference in order to support better understanding of the SDoH. Another important roadblock to consider is the capabilities of the current systems being used at a health system and clinician level, for example, a 2017 Deloitte blog pointed out that in order for SDoH efforts to succeed, “clinical systems must collect data points that can be easily accessed and acted upon to make an impact”. This is much easier said than done and most health systems aren’t in a position to effectively perform this work today.

Patient health outcomes can’t be considered in isolation

So far, I’ve shared my viewpoint that the SDoH are the key to enabling better health outcomes for patients but it comes with challenges, namely the criticality of but difficulties with data.

One data specific barrier is accessing the right kind of data about patients to help formulate a clearer picture about their lives. As the U.S. Office of Disease Prevention and Health Promotion states, “determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health.”

This statement leads me to believe that in order for SDoH initiatives to be successful, lots of collaboration with various organizations at the national, state and local levels will be required to incorporate their data sets, that may not be explicitly related to a patient’s physical health.

An interesting twist to this perspective is that, in the political sphere, there are actions being taken that completely undermine the belief that the SDoH are valuable in improving the health of our populations. For instance, a decision was made by the U.S. Census Bureau to not include LGBTQ+ Americans in the 2020 census as they concluded there was  “no federal data need”.

Meghan Maury, Criminal and Economic Justice Project Director, National LGBTQ Task Force, has been quoted, “If the government doesn’t know how many LGBTQ+ people live in a community, how can it do its job to ensure we’re getting fair and adequate access to the rights, protections and services we need? No previous U.S. Census has ever included LGBTQ+ Americans, which makes it challenging for federal agencies and researchers to accurately track the size, demographics and needs of the community”.

There is plenty of published research and evidence to support that the LGBTQ+ community is marginalized and disproportionately affected by health disparities and poorer health outcomes.

What I find confusing is on one hand health focused research organizations and health systems, to name a few, are emphasizing the utility of SDoH data, but on the other hand the larger political environment and specific policies are acting in direct opposition to the relevance of SDoH data.

So, what does this mean?

While I recognize only one example was cited above, I believe there is an inextricable link between healthcare and politics and when talking about the SDoH and their ability to help achieve better patient health outcomes, unless significant political, policy and cultural changes are made, it’s impossible to talk about patient health outcomes from a purely healthcare focused perspective.

The SDoH is a shift towards humanizing healthcare, so you can’t talk about physical aspects of health (e.g. the physical symptoms of illness or disease) without factoring in the patient’s reality as a human (e.g. educational level, familial support, socioeconomic status, sexual orientation)- which is much broader and complex. Fortunately or unfortunately, depending on your perspective, these humanizing factors are often deeply entangled with and dictated by the political and policy making environment.

Agree? Disagree? Tell me what you think!

LinkedIn: linkedin.com/in/laurenchofmann and Twitter:@LaurenCHof

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