Making Social Determinants a True Vital Sign: Last Week’s Hangout Participants Address Unanswered Questions

Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss how we can work towards making social determinants of health a true vital sign. Moderated by Philadelphia NPR Senior Health Reporter Taunya English, these experts discussed ways to incorporate social determinants of health, such as housing and education, into everyday clinical encounters.

If you were unable to join us, please check out the recast below.

We had so many questions from our audience that our hour-long broadcast was not time enough to address them all (once again, thank you for sending your questions our way!). We asked Pedro “Joe” Greer, Professor and Chair of the Department of Humanities, Health, and Society Associate Dean for Community Engagement at the Florida International University, and Marc Nivet, Chief Diversity Officer of the Association of American Medical Colleges, to weigh in on a few additional questions. Read on to see their responses.

What does the typical medical school include in its social determinants training?

Marc: More than 90 percent of our medical schools include topics related to social determinants. Through the accreditation process, we know that most medical school curricula include didactic and experiential learning programs in community health, health disparities, population health management, and prevention and health maintenance. Medical schools are often starting earlier by integrating this content in premedical programs, like the Summer Medical and Dental Education Program, which includes lectures and community activities to expose aspiring medical students to these issues while in college.

Has it been tough to make room on the syllabus – and convince school administrators that social determinants training is important for future health care providers?

Marc: Through the NIH-National Institute on Minority Health and Health Disparities-funded national learning collaborative Urban Universities for HEALTH, we have learned that leadership involvement is key to transformational change within institutions that leads to measurable improvement in communities. Our project leadership includes presidents of universities as well as deans of several health professional schools including medicine. Because leaders are engaged, strategic plans include a strong focus on training providers that understand the social determinants of health. This has led to significant changes, which include the development of pipeline programs, incorporation of holistic admission practices, and curricula innovations that include training about social determinants.

Does a patient’s socioeconomic status ultimately influence physicians’ decision-making regarding management of patients?

Joe: Unfortunately it does, but by dealing with the social factors perhaps we can make determinations based on medical need, and not a patient’s income.

How do we measure social determinants outside of asking questions?

Joe: We are currently developing a new methodology with the RAND Corporation that is embedded in our electronic health records and Social Portal.

How can we improve health of patients when mental health services are often cut in public system?

Joe: Behavioral health should be intimately tied to physical health. At Florida International University, we are currently trying that model and have hired a psychiatrist to be on our family medicine faculty. We are also working with our social work school and their mental health therapist – as well as the nursing school.

What role does cultural competence play in the provision of care? Is maintaining cultural competence a responsibility of the provider?

Marc: Cultural competence training equips health care providers with a set of knowledge and skills to become responsive to the needs of all patients, not solely racial and ethnic minorities. Cultural competence training helps the provider critically consider how a multitude of factors may influence health and health behaviors including but not limited to their own biases, the patient’s culture, the health care system, and larger societal issues. Once licensed, physicians must participate in continuing medical education to stay current in their field, and this also includes cultural competence training. Hospitals and clinics also provide health care providers with on-site training.

Joe: Cultural sensitivity is vital to improving the health of our patients, from the culture of economics, regions of the USA, country of origin, generations in this country, education, sexual preference, religious beliefs, and on and on.

How might health literacy factor into the issue of social determinants as a vital sign? To what extent is it the physician’s role to educate patients?

Marc: An individual’s educational experiences, socioeconomic background, experience with the health care system and history of access to quality care influence health literacy. Physicians play a critical role in health literacy by working with the patient to assess their ability to understand and follow through on health-related information. Ultimately, it is the responsibility of the health care team and the hospital and clinic leadership to ensure that health information is easy to understand and useful to support the patient’s health.