Patient Support & Advocacy

Social determinants of health: What medical students need to know

Tanya Albert Henry , Contributing News Writer

Where your patients were born, where they work, play and grow older all have a big impact on what their health outcomes will be, with research showing that a person’s overall health is mostly driven by social, economic and environmental factors.

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An  education module offered via the AMA Ed HubTM helps medical students—and residents and physicians who may not have received such training—grasp how these factors affect a patient’s health, how to ask patients the right questions about them, and how to help improve health outcomes and health equity for all patients.

The free online education module, “Health Disparities: Social Determinants of Health,” is one of six modules the AMA Ed Hub recently released as part of the Health Systems Science Learning Series.

The other topics are: health care delivery systems, patient safety, population health, quality improvement and systems thinking. The AMA Ed Hub plans to offer another seven modules as part of the series in early 2020.

The AMA Ed Hub  is an online platform that consolidates all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.

While genetics are responsible for about 30% of a person’s health outcomes, research shows five social and economic factors have big influence too. And these factors, outlined below, are ones that have not traditionally been covered when health professionals gather information from patients.

Economic stability. Poverty, housing stability, food security and employment health. For centuries, there has been a strong link between poverty and poor health outcomes. Also, the unemployment rate affects domestic violence, depression, physical illness and substance abuse rates.

Education. Whether a person has graduated from high school or obtained a higher degree, access to quality early childhood education, and literacy also affect health outcomes. Understanding a patient’s literacy level can help you present information in a way they can understand.

Health. Health insurance coverage, health literacy and access to health care and primary care. For example, low health literacy may make it difficult to navigate the health system, resulting in worse outcomes and higher costs.

Community. Civic participation, discrimination, workplace conditions, incarceration and cohesion in a community. For example, social cohesion has been shown to result in lower mortality rates.

Neighborhood. This broad category covers housing, transportation, access to healthy foods, access to green space, a safe neighborhood, and air and water quality. Inadequate housing, dangerous streets and blighted neighborhoods have a negative impact on health.

Physicians should ask questions beyond typical biological screening questions to determine how patients are impacted by social or economic factors. The AMA module includes a PDF of social history tools to help guide physicians on what questions to ask.

For example, a poverty intervention tool starts with a single screening question: “Do you have difficulty making ends meet at the end of the month?” and follows with interventions the practice team may need to consider when managing that patient.

Once physicians know what socioeconomic factors may be at play, they can be ready to help by having reference materials on hand for patients—for example, where to receive local legal assistance or find nearby food pantries, shelters, translators, child-care services and nutritionists.

And physicians can integrate information they gather into the electronic health record to support research and communication between clinical practice teams and other service providers in the health care system or community.

The AMA also recently released the Health Systems Science Review book, published by Elsevier. The study tool helps physicians-in-training and other health professionals evaluate their competencies in health systems science and helps learners evaluate their readiness for navigating modern health systems. The AMA is working with the National Board of Medical Examiners to develop a standardized exam, which is expected to be available later in 2020.

The review book complement’s the AMA’s 2016 Health Systems Science textbook, which outlines a formal method to teach students how to deliver care that meets patients’ needs in modern health systems. More than 4,000 copies have been sold worldwide, and it is being used in over 30 medical and health professions schools. Both books are available for purchase at the AMA Store.