Health Equity

Why asking about social determinants of health is so important

Tanya Albert Henry , Contributing News Writer

Consider this: A 43-year-old adjunct professor with asthma sits in the exam room. The woman has lost 30 pounds in the past year, without having undertaken a diet regimen. She has a BMI of 18, her vital signs are normal and her physician exam is notable at times only for end-expiratory wheezing.

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She’s up to date on her cancer screenings, with a normal pap smear and mammogram. Her laboratory work is all normal. So too, is all the imaging she’s had done, as were an esophagogastroduodenoscopy and colonoscopy.

Laura Zimmermann, MD, interim division chief of general internal medicine at Rush University Health System, who saw the patient for the first time for a follow-up visit in the resident clinic, asked her if she was ever worried about food. For example, was she having any difficulty accessing or obtaining food? Was she running out of funds or resources before her next paycheck?

The patient’s answer to the questions gave Dr. Zimmermann what she needed to know to help solve the mystery of what was causing the weight loss, Dr. Zimmermann told viewers of an AMA STEPS Forward® webinar on how to engage your practice in addressing social determinants of health (SDOH).

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It turned out that the patient was worried about food and having trouble accessing food. She earned a wage below the federal poverty level and didn’t have enough money to cover basic expenses such as food.

Dr. Zimmerman was able to refer the patient to care management and social work colleagues who then helped the woman obtain a state food-assistance card and provided her referrals to local food pantries.  

“The next time we saw her, she had gained about five pounds and was doing very well,” Dr. Zimmermann said during the webinar.



A prevalent problem

Food insecurity is not uncommon. About 13% of all U.S. households experience it, and it’s even more prevalent among patients from historically marginalized racial and ethnic groups. It’s one of the social factors—along with economic stability; education; health care access, neighborhood and physical environment; and social and community context—that can have an impact on a person’s health and health outcomes.

“What was really a red herring here was the fact that she was an adjunct professor and so people just assumed that she must be doing fine and she must not have any social determinants of health needs,” Dr. Zimmermann said. “This just illustrates that a systematic approach is really necessary.”

The AMA STEPS Forward™ toolkit “Social Determinants of Health: Improve Health Outcomes Beyond the Clinic Walls” outlines eight steps that physician private practices can follow to incorporate these questions and resources into their practices. The toolkit’s tips and resources also apply to practice settings with other types of ownership structures.

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Dr. Zimmermann was joined on the webinar by Marie T. Brown, MD, the AMA’s director of practice redesign; Rachel Smith, program manager for social determinants and health equity at Rush; and Robyn Golden, associate vice president of social work and community health at Rush, to talk about the eight steps practices can take to engage their practice members in addressing SDOH and how Rush has incorporated the practice.

They walked viewers through these eight steps to follow:

  • Understand and engage your community.
  • Engage key leadership.
  • Assess your readiness.
  • Select and define your plan.
  • Assess SDOH at the patient level.
  • Link patients to SDOH resources.
  • Evaluate and refine.
  • Celebrate your success.

Check out this interactive CME course that details the basics of health equity. You can also learn more about the AMA’s strategic health plan to embed racial justice and advance health equity.