Social determinants: COVID-19 reveals societal gaps in care

The COVID-19 pandemic has changed the way people around the world live and work, including how they access health care. COVID-19 is also having a huge impact on social determinants of health (SDOH), those conditions of work, society, environment, race and more that affect our health, experts say.

“COVID-19 is shining the light on where the gaps and weaknesses [in society] are,” says Erin Jospe, M.D., an internist and chief medical officer of Kyruus, a provider data management platform in Boston. She points out the significant difficulties some patients face in accessing and paying food, medications and health care, problems exacerbated by COVID-19. “We must recognize that some of our patients may be feeling (vulnerable) in really acute and potentially tragic ways during COVID-19,” Jospe says.

As a safety precaution during this time, most states have residents sheltering in place. This is a privilege not afforded to everyone, including essential workers, who may already be dealing with a greater number of SDOH than people who are able to stay at home, says Jeffrey F. Hines, M.D., medical director of diversity, inclusion and health equity for Wellstar Health System in Atlanta.

“Many of these people have to take public transportation to their jobs. Then, when they return home, they may be in spaces where it’s difficult to socially distance when multigenerations are living in the same home,” Hines says.

COVID-19 is revealing economic inequalities that are forcing some people to choose between health and financial stability, says Nicole Washington, D.O., M.P.H., a psychiatrist based in Tulsa, Oklahoma. “When everyone is saying ‘stay home’ but your employer is saying ‘we’re open,’ and you have to choose between possibly getting this virus and being able to pay your bills, it makes it very difficult,” she says.

The “economic dislocation” of COVID-19 will have a big impact on nutrition, from both possible disruptions in the food supply chain and unemployed people’s inability to afford food, says Alexandra Schweitzer, M.P.P., a senior fellow at the Mossavar-Rahmani Center for Business and Government at Harvard Kennedy School in Cambridge, Massachusetts.

In addition, Jospe points out the widening digital divide that affects those who can’t access the internet or Wi-Fi services or don’t have acomputer to get online for, say, education and health care. “The inequity between who has certain necessities, like data plans and broadband and high speed internet, have suddenly become (more glaring),” Jospe says.

An inability to connect online has the potential to increase social isolation and degrade mental health. “There’s evidence that social isolation and loneliness affect health,” Schweitzer says.

Physicians can help patients by being proactive and reaching out, says Jospe, who suggests asking patients if they are have trouble with refilling or paying for prescriptions or accessing internet services.

“There’s a lot of fear and uncertainty right now,” she says. “I can say that many of those outreach phone calls that physicians’ offices are making right now are really being warmly met. People feel cared for.”