How Family Physicians Are Addressing the Social Determinants of Health (and Where Public Health Leaders Can Engage)
January 31, 2018 | ASTHO Staff
Health outcomes are inextricably linked to the social and physical environments in which we are born, live, work, play, and age. The Healthy People 2020 framework reflects key categories of social determinants of health, encompassing economic stability and income, the neighborhood and built environment, education, the social context, and access to healthcare services.
ASTHO spoke with Julie K. Wood, MD, MPH, FAAFP, to learn how family physicians are approaching the social determinants of health and to explore the value of partnerships between physicians and public health leaders. Wood is the senior vice president of health of the public and interprofessional activities at the American Academy of Family Physicians (AAFP), where she oversees the AAFP’s efforts to involve family physicians with integration of primary care and public health, health equity, and population and community health. Wood also co-chairs the Population Health Forum, which is a platform for primary care, public health, and others to share ideas, discuss successes and challenges, and create closer connections.
What do the terms “population health” and “social determinants of health” mean to family physicians?
Population health is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig and Stoddart, 2003). The population being considered may vary based on an individual’s perspective and goals. For the family physician, the most obvious “group of individuals” is their patient panel. This is where most AAFP members focus their energies and where they often have the greatest impact. However, population health also includes the health status and outcomes of the larger communities to which the physician and patient belong.
Social determinants of health are the conditions under which people are born, grow, live, work, and age. Family physicians take a leading role in addressing the social determinants of health by partnering and collaborating with public health departments, social service agencies, and other community resources. Family physicians are integral within the continuum of care and use their skills and expertise in caring for patients across the lifespan to reach out to their communities, bridge healthcare gaps, and strive for better health for all.
What are family physicians doing to help improve the social determinants of health? What resources are available to help leaders address this work?
Most family physicians are actively screening for social risks at the point of care and coordinating with community-based, public health resources to address those identified needs. They are doing so with the assistance of a multidisciplinary practice team that includes social workers and community health workers, as well as high-impact collaborations with other organizations such as health departments, school systems and philanthropic organizations. In addition, family physicians recognize that inequitable systems, policies, and infrastructures are the root cause of health disparities in their patient populations, as a result, some are actively engaging their elected officials as advocates for change.
To support family physicians in this work, AAFP developed a Social Determinants of Health Toolkit in January 2018, focusing on screening patients for non-clinical factors that affect health outcomes and referring these patients to appropriate community resources. Additional resources are being developed to enhance education and awareness of addressing diversity, social determinants of health, and health equity at the practice and community levels.
How does your work at AAFP build towards the vision of improved population and community health?
I provide oversight for the AAFP Health of the Public and Science Division, which supports integration of primary care and public health, health equity, population and community health, as well as global health. The AAFP Center for Diversity and Health Equity (CDHE) launched a new priority strategic initiative: to advance health equity from the perspective of building and translating the evidence to support the workforce in advocating for systematic changes to improve health for all. Research indicating that social determinants have negative impacts on health is clear, and the multiple pathways by which this occurs are described in the literature (i.e. adverse childhood experiences, social deprivation, racism, toxic stress, etc.) What is less well understood is the application of individual and population-level interventions to address these risks. The CDHE aims to fill these gaps by synthesizing research, surveying its membership, and conducting analysis to advance the evidence based knowledge in this area.
What can public health leaders offer to their partners in clinical care?
Often, family physicians and other clinical staff are unaware of new or changed community-based resources in their area. Resource listings can be helpful but change frequently; however, relationships between individuals and organizations are the most beneficial. State and territorial health officials, as well as other public health leaders, are vital in achieving population health improvements. They can reach out to their partners in clinical care to identify common goals, develop strategies to maximize organizational resources, and collectively engage key stakeholders to support the needs of the communities they serve.
Ultimately, public health leaders and physicians both know the potential benefits that can be achieved by addressing the social determinants of health, such as improved health outcomes, improved health equity, and reduced healthcare spending. While the tools and approaches of the public health and clinical communities can vary, there is common ground and a shared vision between the two.