Health Equity and the Social Ecological Model

00:01 Ultimately, the reason that we talk about the social determinants of health is because we want to achieve health equity.

00:10 I like this definition of health equity by Doctor Camara Phyllis Jones, who is an anti-racism thought leader.

00:18 She says that health equity is the assurance of the condition of optimal health for all people. And the way that we achieve that is by valuing all individuals and populations equally. Recognizing and rectifying historical injustices and providing resources according to the need of each patient.

00:40 I'd like to share some frameworks with which we can think about the social and structural determinants of health, and how we might address them for our patients. This is the social ecological model.

00:52 We have traditionally, as health care providers, focused on the innermost circle here, the individual wrong of the social ecological model. What are my patients' behaviors? What is the knowledge and attitudes that they bring to their health condition? The social ecological model encourages us to think beyond the individual wrong.

01:17 We look at the interpersonal situation, what are their family and friends and social networks? What kind of community supports do they have? Do they go to church? Do they have any community organizations that they're a part of that can support them in achieving their health goals? And then we go even beyond that.

01:35 Look at the structures, the organizational structures, the policy, the enabling environment, the laws that contribute to the structures that are in place, that influence the social determinants and the health of our patients.

01:49 Now we can't intervene and fix all of these things, but we need to have this broader outlook when we are taking care of our patients, so that we can understand the bigger picture of where we might be able to help and intervene on their healthcare .

02:06 I like this approach to intervention by Doctor Bibbins-Domingo that was recently published, where we can think about the five A's, the categories of health care activities that facilitate addressing social needs.

02:21 Now this is an example that is related to transportation, which our patient Manny did experience transportation-related barriers.

02:31 So this approach encourages us to look at the awareness, the adjustments, assistance, alignment and advocacy opportunities to address the social determinants.

02:46 So for transportation, the kinds of things that we might be able to do. First, we need to ask patients about their access to transportation.

02:55 It's entirely possible we could go through a whole health care visit without even thinking about it. But if we start to have this awareness, then we might be able to ask a patient and start to think about resources for them.

03:08 We could adjust our plans.

03:10 Reducing the need for an in-person health care appointment was one example that we could offer to our patient.

03:17 We can think about assistance programs.

03:20 Are there transportation vouchers in place? Are there ridesharing services or optimizing public transit in a way that they could better achieve their transportation to both work and to their healthcare appointments.

03:34 Alignment. Let's see if we can get our community organizations aligned with the goals of the individuals in our community.

03:43 So our ride-sharing programs need to become more robust.

03:46 Does our clinic need to offer better transportation options for the patients? And finally, advocacy.

03:52 Can we work in a larger structure within the laws and the policies that influence the transportation system in our community to make changes that benefit our patients? This is one way to think about small steps that we can take to approaching large problems. I will leave you with a final thought by Rudolf Virchow.

04:16 If medicine is to fulfill her great task, then she must enter the political and social life. Do we not always find the diseases of the populace traceable to defects in society? Thank you for joining me in this discussion of the social and structural determinants of health.