5.2 Importance of Social Determinants of Health

[Slide: Social Determinants of Health: Part Two]
Slide 1
Hello, I’m Janet Brishke. Welcome to part two of our discussion on social determinants of health. If you have not yet viewed part 1, please watch that video before moving on to this one.

Slide 2
Now that we know what is meant by social determinants of health [acronym defined on-screen: SDoH], we will discuss why they’re so important. I will then cover specific examples of initiatives that focus on social determinants of health. Finally, we’ll cover how Citizen Scientists can impact research by being aware of these factors and how the community is affected by them.

Slide 3
So, why are social determinants of health important? Why do we care about this?
Addressing social determinants of health gets us closer to achieving health equity, or the opportunity for everyone, regardless of circumstances, to reach their full health potential.
Simply trying to tackle the health condition is not enough. Just like it’s important to prevent diseases by eating well or being physically active, addressing social determinants of health can help prevent health problems down the line- for both the individual and the community.
By understanding the real-world challenges their patients face, clinicians can improve patient care and offer more realistic, specific suggestions.
Similarly, by understanding the challenges being faced by community members, referrals can be made to social organizations who may be able to help.

Slide 4
We have analyzed data from our catchment area, and found that advanced cancer diagnoses here are higher than what’s typically seen in the state of Florida overall. Advanced-stage diagnoses in cancer are 17% higher for those living in areas of high social vulnerability.
Mortality, or death, is also linked to social vulnerability, with Black males and females living in rural areas at the highest risk of mortality from prostate or colorectal cancers and breast or uterine cancers, respectively.
We’ve also seen the lowest screening rates for breast, colorectal, and cervical cancers in our areas of high social vulnerability.
These findings all point to the vulnerability of those in our catchment area. Advanced-stage cancers are much harder to treat, and the outcomes are not as good. These cancers may be advanced stage for different reasons: maybe the person didn’t get a routine screening like a mammogram that could have detected breast cancer earlier, when it was easier to treat. Or perhaps the person has a type of cancer that’s usually only detected in later stages, like pancreatic cancer. Social determinants of health matter- it matters when you get diagnosed, because that impacts your long-term outcome and quality of life.

Slide 5
[map of Florida with Alachua County emphasized, showing geographic distribution of social vulnerability]
We know that social determinants of health are important, but how do we act on this? How do we address policy issues that range from health to education to employment? How do we assess what’s going on at the individual level and then translate that into something we can do for individuals and also for the community? It’s overwhelming, so let’s focus on how we can address social determinants of health using a specific example that we’re working on related to cancer screenings. We have a project underway with the University of Florida Community Health and Family Medicine that is a great example of the work being done to increase cancer screenings. The east side of Gainesville has higher poverty levels, lower educational attainment, unemployment, and many other challenges compared to the rest of town. This social vulnerability is indicated by the dark blue shading on the slide.

Slide 6
[diagram depicting elements covered in an electronic health record-based social determinants of health screening, with categories such as social factors, psychological response, and health behaviors, and examples of need-based topics participants are asked about, like transportation or food referral]
One of the things we’re doing is assessing social determinants of health at the individual level. We’re working with our electronic health record system, EPIC, which has a module with a series of questions about social determinants of health. We’re using that module alongside clinic visits: patients can complete the information beforehand and the data can be sent to their nurse or doctor ahead of their visit, or the questions can be answered in the waiting room as they wait to be seen. The questions in the module address different areas, including various transportation, financial concerns, housing instability, what resources the family has available to them, and whether the family is worried about paying for food (or, food insecurity). The questions also cover topics like social support, alcohol use, and intimate partner violence, among other things. These questions cover a lot of topics in order to get at the potential vulnerabilities patients are facing that need to be addressed if we’re going to make any progress on cancer screenings.

Slide 7
[text on slide: “Promote Cancer-related Screenings & Follow-up & Link to Services”; image of health care professional and patient in a clinic; text on slide: “UF Health Family Medicine- East”]
Our project works to use those questions to link people to needed resources. Some of the resources we’ve been referring to include Elder Care, community food banks, opportunities to get relief in paying utility bills, and financial management counseling. People are linked to those resources so that we can help begin to reduce their barriers to care. We’re also working with a partner to provide transportation services, as we know that this is a huge barrier to accessing health care because many people simply can’t get to their appointments. This is an example of the effort the UF Health Cancer Center is making to address social determinants of health. We’ve analyzed where our challenges are by using mapping tools to identify those counties, as you saw in the maps from the previous presentation, and then we brought it down to the community level so that we can work within the community that needs the support. We’re excited about this project, and hopefully, we will be improving cancer screening rates and health outcomes as part of these efforts to address social determinants of health.

Slide 8
As a Citizen Scientist, you are critical to our efforts to address social determinants of health. You have a connection to the community.
Your perspectives on how we incorporate issues of social determinants of health into cancer research is essential, from identifying topics that are important through how we: design the study, interpret the findings, and get the results back to the community. Your insights in how to address social determinants of health in ways that are meaningful to communities and patients is also very important. We need to hear from your experiences- What are the interventions that can work? What will actually make a difference?
Your insight and input as collaborators on a research team is greatly valued and needed.
And of course, your role related to social determinants of health- We want to hear your ideas. How do you see this critical piece of what we do to improve health outcomes? We want to hear from you how we should shape that.

Slide 9
To summarize what we’ve covered in this lesson:
Addressing social determinants of health combats disparities and brings us closer to health equity.
Clinic-based screenings, either in the waiting room or done ahead of time, can help identify social determinants of health and lead to community referrals and linkages to resources, as we’re seeing in the work done at UF Health clinics.
Citizen Scientists, as community members, are critical partners in identifying, incorporating, and addressing social determinants of health. Thank you for watching, and for the work you do as a Citizen Scientist.