COMMENTARY

Agents of Change: 4 Ways to Battle Social Determinants of Health

Shivani Agarwal, MD, MPH; Mark Harmel, MPH

Disclosures

June 29, 2021

This transcript has been edited for clarity.

We all know that social determinants of health affect health outcomes in a major way. We've recently become more aware of these social determinants of health with rising inequities in COVID-19 across the globe, and especially in diabetes.

Some [negative] social determinants of health could include housing insecurity, food insecurity, lack of access to high-quality healthcare, and financial hardship and being unable to pay for medications that are life-saving. We know that [negative] social determinants of health increase the risk for prediabetes and diabetes, as well as the risk for poor diabetes control, complications, and, unfortunately, premature mortality.

So, social determinants of health are really enmeshed in our societies, in our healthcare systems, in every structure that we face in our lives. And it can feel overwhelming to understand as healthcare providers. How do we battle this? How do we help our patients navigate social determinants of health? I've had to really face these questions, and there are certain things I do that I'd like to share with you today that will help you think of yourselves as change agents.

As healthcare professionals, we really have to think of ourselves as people who can change the face of healthcare. We have a responsibility to do so, and it can be done in small ways that may lead to larger outcomes.

I follow four different approaches: standardize, individualize, act, and advocate.

1. Standardize

I make sure that all of our patients have the same access to screening procedures for complications, to bloodwork, to eye exams, and to foot exams. I also make sure that they all have the same information access. So, whether these patients choose to use technology devices, whether they want to use the latest oral medications or injectable medications for their diabetes — they should have access to all of the information to know what's out there, to be able to make informed decisions and for us to help them through that.

2. Individualize

At the same time, I individualize my care. While I'm trying to standardize screening and information access, I make sure that I understand where my patients are coming from. I talk to them. I have conversations with them about their unique issues and the unique barriers they face, whether it be that they lost their job and all of a sudden they can't pay for their insulin, or they unfortunately lost their housing and they're living out of their car.

These are things that will clearly impact health and the way we deliver our care. Making sure that we are in touch with our patients and we're employing shared decision-making so that they're involved with their care will improve their health and improve our relationship with patients to make sure they can do well.

3. Act

The next step is act. I try to do at least one thing, whatever it is. It can be small. It can be on the patient level, the practice level, or even the health system level, trying to bridge community care with health system care. But I choose one thing and I commit to it, and that actually makes a huge difference.

We have to avoid fatalistic attitudes. It's very hard. It can be very hard work, but if you commit to it, it will work, I promise you.

4. Advocate

The last thing I do is advocate. I advocate for our patients. We're in places of privilege where we can do so. We need to give the underserved a voice. We need to be able to listen to them about their unique lived experiences and help craft programs and ideas and creative solutions that will actually work for the people we are serving instead of making assumptions for them.

So, these are the four things I follow. I have felt like my job satisfaction has increased, our patients are happier, and our patients are coming back and are more engaged in care. I hope these will help you as well.

Shivani Agarwal, MD, MPH, is an assistant professor and director of the Supporting Emerging Adults with Diabetes (SEAD) program at the Albert Einstein College of Medicine-Montefiore Medical Center, and an elected member of the American Diabetes Association Health Care Disparities Committee. Her research has focused on developing care models for young adults with type 1 diabetes transitioning from pediatric to adult care, and identifying and reducing racial/ethnic disparities in type 1 diabetes care.

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