Social determinants of health: The COVID-19 pandemic has widened the gap

Before the COVID-19 pandemic, there had been much study and focus on the effect of social issues on the cost of health care and the overall health of the population, including the marked disparities in access to care for many segments of our population. In the last year, these disparities and their effects on our patients have widened.

The question before us now is, do we have the national courage, compassion, leadership and unity to begin to address the core issues underlying this problem of equity?

An excellent Kaiser Foundation report summarizes the key categories defining social determinants of health as economic stability (jobs and poverty), neighborhood and physical environment (housing and safety), education, food, community and social context (community and family supports) and health care system (coverage, access and quality).

There are many innovative projects, including in my native North Carolina, that hold great promise. The learnings from these state initiatives will go a long way to educate us on the most successful strategies, the cost of these strategies and the answer to the questions around the impact of each element on health.

From my personal perspective, from years of practicing as a small-town family physician, the importance of social determinants, recognizing them and their impact on my patients’ health is and was a matter of daily practice. In primary care, we embrace continuity, comprehensiveness and long-term relationships with our patients. Social determinants are just part of that.

This knowledge is enhanced over the years by many patient visits, not to mention the casual interactions at high school ball games or the store.

The importance of knowing your patients and their families beyond themedical facts was immediately made clear to me after I started practice and assumed the practice of a physician who spent his 43-year career caring for our community. Often I would stop by to tell him of my day or sometimes describe a difficult case or a patient I was having trouble understanding the cause of their medical issues. He would immediately tell me about the patient’s entire social and family history and the circumstances impacting the current medical condition. This was learned from years in the community but also through the trusted doctor-patient relationship.

That experience and what I learned in those early days of practice was carried throughout my years in active practice. It made me a better physician and is a key attribute defining comprehensive primary care. In our small town, it also included the knowledge of who might be of assistance in a crisis for my patients, whether it be a church, local program or a caring neighbor.

But knowing and identifying the social determinants is not enough. It must also include how we make progress in addressing the issues that have led to such disparities.

Since high-quality and available primary care improves access, lowers costs, and improvesoutcomes, it’s obvious that supporting primary care and addressing social determinants should be linked. My solution is simple. Invest in making sure our citizens have access to adequate and available primary care, then use the savings generated to address and solve the many obstacles and social issues facing our patients and our communities.

L. Allen Dobson Jr., M.D., FAAFP, is a family physician and Editor-in-Chief of
Medical Economics®.