Do some people struggle to access healthcare? Is low income or lack of insurance a struggle that people face when trying to pay for healthcare? What about the ability to pay for well-balanced food for their families, or the ability to send children to quality schools? Do these factors pose issues for some patient populations?
The answer is a resounding “OF COURSE.” The best attempt at explaining and analyzing these various factors has resulted in the concept of Social Determinants of Health (SDoH).
You may have heard the term before, which would make sense because in recent years the concept of SDoH has become a common topic of discussion in the healthcare world. The issue at hand is in the U.S., the vast majority (95%) of health expenditures go toward medical care, yet many experts agree medical services alone have a limited impact on overall health and well-being.
In order to assess, and ultimately improve, the overall health of patient populations it’s important to take into account the full picture of a person’s environment and the myriad of factors that have an effect on their health. SDoH include a variety of different factors such as where people live, learn, work, and age, as well as socioeconomic factors including economic, cultural and linguistic attributes.
The challenge in front of the healthcare industry today is to figure out ways to address and improve the status of SDoH to reduce or outright avoid future health complications and thus, avoidable healthcare costs for patients. Pharmacists are well-positioned to take an active role in addressing these factors, and can help to lead the charge in working to mitigate the effects of the negative determinants in patients’ lives and environments.
To explain the effects of SDoH in more practical terms, let’s walk through an example of two different individuals and analyze their situations to see how their social determinants might impact their overall health and well-being.
First, we have James, an 18-year old in an affluent suburban neighborhood. James grew up in a large house, with a big yard and convenient access to nearby parks where he could do a number of outdoor activities and sports. He was fed a healthy diet of quality foods throughout childhood which his parents purchased from local organic grocery stores. James’s parents took him to regular doctor and dentist appointments growing up, and he attended a good school district that had an excellent health program which regularly had local healthcare professionals come to the school to conduct seminars on healthy behavior. James plans to go to a good college after high school and major in computer engineering, and socioeconomically he will likely be in the upper-middle class after he graduates and starts his career.
Second, we have Stephen, an 18-year old in an impoverished urban neighborhood. Stephen grew up in a two-bedroom apartment with a single parent and multiple siblings. Living in the city, there is not ample access to nice parks for Stephen to go and play. Due to the low income of the household, dinner was often prepackaged boxed foods and other inexpensive food options with low nutritional value. With poor insurance coverage, doctor and dentist appointments were few and far in between. The school district he attends does not have great health education, and in order to help pay the bills, Stephen has to work a job after school, leaving little to no time for homework. For him, college seems like a luxury he can’t afford, so he plans to go to work directly after high school in a job requiring manual labor and no college degree.
Between the two, you can see how James would have a significant leg up on Stephen in terms of establishing healthy habits in his adult life. James got plenty of exercise growing up, was fed a steady healthy diet, received a good education, and will have a safe job that requires little to no physical strain and likely will provide quality insurance benefits.
Stephen grew up without ample opportunities for exercise, a poor diet, and will be working a physically demanding job that will have negative consequences on his body in the years to come.
Each individual has social determinants of health all around them, but for James, the determinants lead to a positive well-being, while for Stephen the determinants suggest a negative future outcome. This is the task in front of healthcare professionals today; to intervene, understand the SDoH for those at a disadvantage, and find ways to circumvent them.
Why are pharmacists well-fit to address SDoH?
Pharmacists are among the most visited and trusted healthcare professionals in the industry. On average, patients see their pharmacist 35 times per year, about 7 times more than they see any other healthcare provider. With this level of trust and exposure with patients, it presents ample opportunities to play a more active role in the health of their patients and communities.
Social Determinants of Health show us there is much more to a patient’s health beyond the medical treatment they receive or even their adherence to medication regimens. Pharmacists are highly educated healthcare providers capable of providing so much more value to patients beyond medication dispensing. Pharmacists can utilize the tools and resources available today to help their patients and communities overcome the SDoH that negatively impact their wellness and outcomes.
How can pharmacists address SDoH?
We’ve already established that SDoH consist of factors such as where people live, learn, work, and age, as well as other socioeconomic elements. Now to consider how you as a pharmacist can address SDoH, let us together think through some of the main factors, analyze the possible ways to intervene, and improve the situation for an underserved patient group.
Where people live:
As a pharmacist, you can’t very easily change peoples’ access to quality parks and walking trails, but you can improve their access to your services. One way to increase pharmacy access for underserved patient populations is through telepharmacy. By establishing a pharmacy presence in underserved communities it allows people to not only access prescription medications that will help improve therapy outcomes, but you’ll be able to develop relationships and provide valuable counseling to patients on how to improve their specific health situation and habits. Implementing telepharmacy inside nursing homes, long-term care facilities, federally qualified health centers, or other specialty clinics is one way to increase access and convenience for patients who might otherwise have difficulty obtaining their prescriptions and pharmacist counseling.
Where people learn:
While changing the quality of an entire school district is not a likely feat for anyone to accomplish, pharmacists can intervene where people learn by making a concerted effort to get involved in local schools. If you’re a pharmacist with a local school district that seems to be lacking in health education, make your voice heard and get involved. Reach out to school districts in need and offer your own services, whether it be holding an in-school seminar about basic health essentials, or even providing flu shots and other testing services at the school.
Where people work:
There are a lot of opportunities for partnership with employers, depending on the location. Telepharmacy on large employer campuses is one way to make your services accessible for employees and to ensure they fill their prescriptions, but there are other ways to have an impact in these settings as well. Perhaps a routine health monitoring clinic or other health tests can be performed on a regular basis so the employee and you can keep tabs on their health and help identify any serious issues at the outset, and the employer can streamline and centralize the provision of healthcare services under one umbrella.
These are some ideas for you to consider as you think about how you might help address the SDoH for the patients in your community, but there are many, many more possibilities. Be creative and think about your specific community and the needs around you that aren’t being met, and explore opportunities to intervene.
Pharmacists are in a position to make an impact and lead the charge when it comes to Social Determinants of Health, and hopefully this serves as a launching point for you to begin the process of implementing practices that benefit your patients, while also working collaboratively with other local providers, local officials, and local organizations to put in place initiatives that improve the health of the patients and the community you serve.