Introducing Social Determinants of Health Michigan Osteopathic Association 119 th Annual Spring Scientific Convention May 18, 2018
Learning Objectives v Define Social Determinants of Health v List three Social Determinants of Health that may impact personal health v Show a tool that can assist a health care professional identify Social Determinants of Health v Describe how Social Determinants of Health impact risk stratification 2
Let s Find Out: Have You Heard About Social Determinants fo Health? 3
The First Question v How do we as healthcare organizations respond to the need for more partnerships -- not with just individuals and families but also with nonmedical community-based organizations? 4
The Second Question v How do integrated organizations help transform and redesign the way primary care, and even specialty care, is delivered to achieve value, not necessarily volume? v How can integrated organizations manage the health of populations, instead of thinking about individual levels of care? 5
The Third Question v How do we become more perceptive and responsible in terms of financial management and have structures and processes in place to ensure that we understand how to pay for services and that achieve performance and value? 6
Another Question v How do we ensure that our systems, our healthcare organizations, and the way we operate are integrated with larger organizations outside of health care? 7
8 Collaboration and Cooperation
Listen to the Parable v Three friends see children being carried away in a rushing river. One goes downstream to catch the children before they reach the rapids; another grabs a canoe. This Photo by Unknown Author is licensed under CC BY-NC 9
Listen to the Parable v The third friend swims away in the opposite direction. When her friends ask why, she answers: I m going upstream to find out who is throwing these children in the river. 10
Paying Attention to Social Determinants of Health v Rishi Manchanda, MD, MPH believes health care can be transformed if doctors and clinicians are encouraged to look beyond the symptoms to what he calls the cause of the cause of a patient s illness. 11
Upstreamists Are Popping Up v Like the third friend in the parable, healthcare professionals are beginning to look upstream for the source of patients ills. 12
Who Is Spreading the Word: Upstreamists v Rishi Manchanda is traveling the country explaining to doctors and clinicians why examinations should include questions not just about the patients symptoms, but also about their homes, neighborhoods, access to fresh produce and physical activities. 13
Who Locally Is Making a Difference v A doctor or clinician may write a prescription after an exam. v In Dr. Manchanda s instance he may ask a community health worker to help the patient identify and get rid of health hazards from the home. v In Detroit the MOA has an upstreamist, Richard Bryce, DO 14
CHASS and Richard Bryce, DO v Richard Bryce, DO recently received the coveted PCPCC Advanced Primary Care Practice Award v Innovative work at the Community Health and Social Serviced (CHASS) located in Detroit. v He promotes healthy lifestyle to his patients. v He champions the Fresh Prescription Program. v He utilizes readily-accessible neighborhood resources. 15
Definitions v Social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. World Health Organization (WHO) 16
Check Out Each Word v Social: interactions with the external environment such as your friends, family, places, and different systems. v Determinants: indicators, something that is determined or influenced by v Health: physical, social, spiritual, and mental health. 17
There is Evidence v Spending more on health care does not result in significant improvements in population health. v Factors such as living and working conditions are significantly important for a healthy population. 18
Cause of Health Inequities v The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between geographic areas. 19
Health Inequities v Roots lie within education, labor, housing, urban planning, government regulation, health care systems. v Powerful determinants of health since individuals have little or no direct personal control. v Can only be altered through social and economic policies and political processes. 20
21 My Old Neighborhood in Detroit
Determinants v Social support v Early child experiences v Employment v Housing v Transportation v Food Environment v Social standing 22
Personal or Family Income Affects Health v Income directly affects Nutrition Physical activity Housing quality Neighborhood conditions Social networks and support Stress due to inadequate resources to face daily challenges Healthcare 23
Personal or Family Income Affects Health v Parents income shapes the next generation s education v Which shapes the next generation s Working conditions (physical and psychosocial) Income 24
Children Raised in Poverty v Have lower levels of educational attainment More likely to score lower on standardized tests, be held back a grade, drop out of high school Attend schools with fewer resources Suffer from poor nutrition, chronic stress, and other health problems that interfere with their school work Change addresses and schools frequently as their families struggle to find affordable housing Less likely to get a college degree More likely to live in poverty as adults and have lower earnings 25
26 Detroit Neighborhood Map
How a Neighborhood Affects Health v Safe places to exercise v Access to healthy food v Exposure to targeted advertising of harmful substances v Social networks and support v Norms, role models, peer pressure v Fear, anxiety, stress, despair v Violence and fear v Quality of schools 27
SDOH Tool Domain Question Response In the past month, did poor physical or mental health keep you from doing your usual activities, like work, school or a hobby? Yes No Healthcare Food In the past year, was there a time when you needed to see a doctor but could not because it cost too much? Do you ever eat less than you feel you should because there is not enough food? Employment & Income Do you have a job or other steady source of income? Yes No Housing & Shelter Utilities Childcare Education Are you worried that in the next few months, you may not have safe housing that you own, rent, or share? In the past year, have you had a hard time paying your utility company bills? Does getting child care make it hard for you to work, go to school or study? Do you think completing more education or training, like finishing a GED, going to college, or learning a trade, would be helpful for you? Yes No Yes Yes Yes Yes Yes No No No No No Transportation Clothing & Household General Do you have a dependable way to get to work or school and your appointments? Yes No Do you have enough household supplies? For example, clothing, shoes, blankets, mattresses, diapers, toothpaste, and shampoo. Yes No Would you like to receive assistance with any of these needs? Are any of your needs urgent? Yes No Yes No 28
Social Determinants of Health Quetionnaire v Review the template v Significance of capturing this information v Use of ICD-10 and where to capture them v Risk stratification and zip codes 29
Social Determinants of Health Questionnaire: Introduce and Discuss v How do community linkages fit in v How a care coordinator or community health worker assists after a SDOH is identified v When run report to identify if the SDOH referral is compete 30
Recap v Identify one social determinant v An SDOH Survey should be completed in a pediatric practice v A care coordinator is not available how does a patient receive a referral to a community agency v Reach out to Aunt Bertha v Check out NeighborUp 31
32 Questions