IOM Panel Calls for Training in Social Determinants

Alicia Ault

March 08, 2016

An Institute of Medicine (IOM) committee is recommending that an understanding of the social determinants of health be incorporated into the education and continuing training of healthcare professionals — and that healthcare professionals also learn how to take action to address issues that can have an outsized impact on their patients' health.

"Educating health professionals about the social determinants of health generates awareness of the potential root causes of ill health and the importance of addressing them in and with communities," according to the panel's March 7 report, A Framework for Educating Health Professionals to Address the Social Determinants of Health.

If social determinants are not addressed in some way, "the risk of perpetuating a cycle of inequity, disparity, and inequality will remain for generations to come," the report authors write.

The 10-member Committee on Educating Health Professionals to Address the Social Determinants of Health made recommendations on how institutions and educators can make social determinants an integral part of the curriculum. For the most part, the issue has been addressed, if at all, by its being offered as an elective, panel chair Sandra D. Lane, MD, told Medscape Medical News. That has not effectively increased knowledge or improved healthcare outcomes, said Dr Lane, who is the Laura J. and L. Douglas Meredith Professor of Public Health and Anthropology at Syracuse University, in New York.

"I'm confident that [the IOM report] can make a really big impact," she said.

Although the report is aimed at educators, it contains a call to action for practicing clinicians, said Dr Lane. "Excellent medical care isn't the only thing that creates health," she said. "What creates health is the range of things that people experience in their lives."

The report sets up a framework to help the practicing healthcare professional work with the community to address issues such as lack of access to nutritional food or safe housing, said Dr Lane. She points to Mona Hanna-Attisha, MD, as an example of someone who used social determinants to help her patients. The Flint, Michigan, pediatrician was able to trace her patients' high lead levels to a poisoned water supply.

"She is a hero," said Dr Lane. "We're not trying to make everybody into a hero, but we're trying to make sure this isn't the one person who has the courage or foresight to be able to do something" by creating a more systemized approach to education.

Four Recommendations

The committee issued four main recommendations:

  • Educators of healthcare professionals should use the framework presented in this report as a guide for creating lifelong learners who appreciate the value of relationships and collaborations for understanding and addressing community-identified needs and for strengthening community assets.

  • To prepare healthcare professionals to take action on the social determinants of health in, with, and across communities, healthcare professional and educational associations and organizations at the global, regional, and national levels should apply the concepts embodied in the framework in partnering with communities to increase the inclusivity and diversity of the healthcare professional student body and faculty.

  • Governments and individual ministries (eg, signatories of the Rio Declaration), healthcare professional and educational associations and organizations, and community groups should foster an enabling environment that supports and values the integration of the framework's principles into their mission, culture, and work.

  • Governments, healthcare professional and educational associations and organizations, and community organizations should use the committee's framework and model to guide and support evaluation research aimed at identifying and illustrating effective approaches for learning about the social determinants of health in and with communities while improving healthcare outcomes, thereby building the evidence base.

Dr Lane has disclosed no relevant financial relationships.

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