The Role of Social Determinants of Health

Written by Thomas Jorno

Nick Blonski, SPT

I have have had the opportunity to work in a pro bono lab and volunteer at an adult men’s homeless shelter. Having these chances to work with an underserved population and having to problem solving ways to modify home exercise programs to fit with their daily lives has developed a deeper sense of just how impactful social determinants of health can be on an individuals access to healthcare. 

Social determinants of health can be broken into two broad concepts: structural and intermediary, these two concepts play a role in determining an individual’s social determinants of health. The structural concept refers to socio-economic status, politics in the area, ethnic group, etc., whereas, the intermediary concept consists of factors such as money for food, living environment, access to food. These two concepts can affect an individual’s health exclusively but can also begin to affect an individual’s health together through social cohesion and social capital when others are willing to make sacrifices to help these individuals out in lower socio-economic environments.1 

Individuals that are raised lower socio-economic living environments are at an increased risk of having poor development, lower education achievement, and lower levels jobs when they are older. This can be tied into their intermediary concepts as some of these individuals are raised in environments that use lead paint in the walls and this can lead to permanent changes within a child’s brain.2 This can biologically condition this child to remain in the lower socioeconomic class where health care and healthy lifestyles are harder to come by.2 This stood out to me as an area that I didn’t even realize was playing a role in the disparity that faces many individuals in our country. Coming from a background where I never experienced these situations it was hard for me to conceptualize how much of an impact that lifestyle can have on an individual not just socially but also biologically. As a health care provider it becomes our responsibility to bring these types of living environment situations up to our legislators and representatives, and to provide these individuals with factual and scientific evidence about how this is affecting these children’s health and long-term quality of life.

Looking at the APTAs stance on health, wellness, and fitness physical therapists have a unique opportunity to educate the community, provide direct intervention to individuals, participate in research, advocate for health care changes and policy changes, and to collaboratively consult with other individuals in these areas.5 Another area that we can provide input in health, wellness, and fitness is by adding our knowledge on adapting community environments, such as parks and community centers, to be accessible for all individuals.5

As therapists, we can play a major role in reducing health care disparities. One way is by providing pro-bono clinics for individuals that are unable to afford convention for profit physical therapy clinic models.3 For many this may seem like a stretch when you start to think about the financial burden this can place on a clinic but it can be made realistic by having new pro bono programs join the Pro Bono Incubator program put on by Move Together. This program works to help initially support the development of these new programs. We can also bridge the gaps between ethnic groups by having the patient take control of their care and by us as therapists asking simple questions like “Who supports you and helps you make decisions?”3 We can also bridge this gap by translating our screening guidelines and early intervention recommendations into forms that work for different cultures and ethnicities.3 

Social determinants of health add another level of complexity to the patients that we treat and the members of society that could benefit from therapy but are unable to access therapy services. By taking a role as an advocate for these patients and the community as a whole we can have an impact at the legislative level and among community organizations to provide safe and affordable options for individuals to participate in physical activity or areas that individuals can go to complete home exercise programs. It isn’t necessary to completely change your practice to solely focus on changing the landscape of the social determinants of health, but if all therapists and student therapists could take minor action we could see a large scale change that benefits our patients and society as a whole access to health care.

References

Social Determinants of Health- an introduction. YouTube. http://www.youtube.com/watch?v=8PH4JYfF4Ns. Published 2017 Jun 25. Accessed 2020 Feb 25.

Braveman PA, Egerter SA, Mockenhaupt RE. Broadening the Focus The Need to Address the Social Determinants of Health. Am J Prev Med. 2011;40(1S1):S4-S18.

Lehmann C. Addressing Social Determinants of Health. PT in Motion. 2019. www.apta.org/PTinMotion/2019/7/Feature/SocialDeterminants/. Published 2019 Jul. Accessed 2020 Feb 25.

Social Determinants of Health: Know What Affects Health. Centers for Disease Control and Prevention. http://www.cdc.gov/socialdeterminants/. Updated 2018 Jan 29. Accessed 2020 Feb 25.

Physical Therapists’ Role in Prevention, Wellness, Fitness, Health Promotion, and Management of Disease and Disability. American Physical Therapy Association.

http://www.apta.org/uploadedFiles/APTAorg/About_Us/Policies/Practice/PTRoleAdvocacy.pdf​. Updated 2019 Sep 20. Accessed 2020 Feb 25.

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