The social determinants of health may be the reason for your illnesses. In plain language, it's the way the environment influences your health. Do you have clean air and water? Is your neighborhood high crime? Can you walk at night a block to a supermarket without being assaulted or robbed? Do you hear gunshots near your home at night? What about the air pollution from high traffic rates or industrial smog near your home?
How safe are you on a daily basis? How close is the exposure to violence? All these factors add up to chronic stress on kids and their families. Add to the mixture unhealthy foods and you have a scenario for diseases triggered by all these stressors. Can patient centered medical home help? One way to start is to assess social health determinants and promote health.
Physicians from the Departments of Pediatrics and Family Medicine at Boston Medical Center (BMC) and Boston University School of Medicine (BUSM) are proposing that current pediatric guidelines and practices could be implemented within a Patient Centered Medical Home model to address social determinants of health. The article, published in the Journal of the American Medical Association (JAMA), also suggests that these guidelines could reduce socioeconomic disparities in health care for all patients, according to the April 25, 2013 news release, "Patient centered medical home helps assess social health determinants and promote health."
Arvin Garg, MD, MPH, assistant professor of pediatrics at BUSM and pediatrician at the Boston University Medical Center (BMC), served as the study's first author. Barry Zuckerman, MD, professor of pediatrics at BUSM and a pediatrician at BMC, and Brian Jack, MD, Chief and Chair of Family Medicine at BMC and BUSM, were the article's co-authors. A Patient Centered Medical Home (PCMH) is a comprehensive and coordinated health care model in which a team of providers coordinate all of the patient's health needs, including management of chronic health conditions, visits to specialists, hospital admissions and routine health screenings.
Socioeconomic disparities continue to play a role in the health of children and families. Previous studies have shown that the environment in which a patient lives can impact their health, and these factors have historically been managed by public health and community organizations. However, a PCMH model allows for physicians to play a role in examining the social determinants of health in order to assess and treat patients with a more holistic approach and improve population health.
The authors list five recommendations to help address social context of patient care within the PCMH model: making social determinants of health an important aspect of clinical guidelines; screening for particular social determinants at medical visits; helping patients and families access community based resources, such as Women, Infants, and Children (WIC), job training and food pantries; implementing "outside the box" multidisciplinary primary care interventions, such as programs like Reach out and Read, the Medical-Legal Partnership and Health Leads (developed at BMC); and integrating home visiting programs to better understand living conditions.
They suggest that the implementation of these guidelines will provide important data about the types of services necessary to improve population health. Additionally, the indicators related to social determinants of care may some day become part of pay for performance and quality evaluation metrics of the medical home model.
"Overall, implementing social determinants of health within the PCMH model will potentially reduce socioeconomic disparities in health that continue to exist today and ultimately improve the health care system, especially for PCMH's that serve low-income patient populations," explains the authors, according to the news release.
The authors note that the "medical home" is not a novel concept in the world of pediatrics. Current guidelines and practices within pediatrics now address social risks of populations and these guidelines are adaptable to adult and elderly populations within the medical home as well. For more information, check out "The Upstream Doctors - Prevention Institute," "Q&A: Doctor goes upstream to find root cause of patients' medical problems," or the news release, "Tackling the social roots of health inequities." Or see, "Oregon Farm to School bill would benefit health through job creation, study finds."
The Prevention Institute
The Prevention Institute, in partnership with the Center for Care Innovations, UCSF's Institute for Physician Leadership, HealthBegins, and Public Health Institute, discusses a book which you may wish to read. The book is about a compelling blend of stories and analysis, The Upstream Doctors. What the book is about is a vision of the future of health care.
Future health care needs to depend upon on growing a new generation of health care practitioners who look upstream for the social and environmental sources of our problems, rather than simply go for quick-hit symptomatic relief. The Prevention Institute's article explains how our high-cost, sick-care system could become a high-value, health care system. What it's going to take are health care professionals who are 'upstreamists', as the book author of The Upstream Doctors, Rishi Manchanda calls them.
What upstream doctors can do is find the root causes of illnesses, the sources and how the stress starts, the environmental pollution and other factors. By upstream, looking for the source, the roots of disease, health care can point to causes instead of putting bandages on symptoms. The triggers of disease and illness is what's at the root. Rishi Manchanda's The Upstream Doctors has been called 'compulsory reading' for anyone concerned about the future of medicine, prevention, and the social determinants of health. The book has quickly become one of Amazon's best-selling Kindle Singles. Check out this book if you are interested in preventive health answers. Your next step would be to look at personalized medicine.