Integrating Rehabilitation and Social Care: Opportunities for Advancing Research, Training, Practice, and Policy

Abstract

The World Health Organization (WHO) describes “the conditions in which people are born, grow, live, work and age” as social determinants of health (SDOH). 1 Office of Disease Prevention and Health Promotion. Social determinants of health. Available at: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed October 25, 2021. Google Scholar Population or community level SDOH manifest at the individual level as social needs. 2 Auerbach J Castrucci B. Meeting individual social needs falls short of addressing social determinants of health. Policy Pract Public Hum Serv. 2019; 77: 25 Google Scholar As the quality of SDOH declines and unmet social needs increase, worse health outcomes are observed, accounting for one-third of total deaths in the US annually. 3 Artiga S Hinton E. Beyond health care: the role of social determinants in promoting health and health equity. Kaiser Family Foundation, 2018 Google Scholar , 4 Davidson KW Krist AH Tseng C et al. Incorporation of social risk in US preventive services task force recommendations and identification of key challenges for primary care. JAMA. 2021; 326: 1410-1415 Crossref PubMed Scopus (19) Google Scholar , 5 Wilkinson RG Marmot M WHO Healthy Cities Project, World Health Organization. Social determinants of health: the solid facts. 2nd ed. WHO Regional Office for Europe, Copenhagen2003 Google Scholar Globally, the SDOH are recognized to be responsible for 70%-90% of a person's health and are even more influential in health outcomes for vulnerable populations, such as persons with activity limitations and participation restrictions. 6 Huffstetler E, Quincy L. Addressing the unmet medical and social needs of complex patients. Available at:https://www.healthcarevaluehub.org/advocate-resources/publications/addressing-unmet-medical-and-social-needs-complex-patients. Accessed October 25, 2021. Google Scholar , 7 Magnan S. Social determinants of health 101 for health care: five plus five. Washington (DC): National Academy of Medicine; 2017. Google Scholar , 8 Hotter B Padberg I Liebenau A et al. Identifying unmet needs in long-term stroke care using in-depth assessment and the post-stroke checklist - the managing aftercare for stroke (MAS-I) study. Eur Stroke J. 2018; 3: 237-245 Crossref PubMed Scopus (35) Google Scholar , 9 Shahsavari H et al. Upper limb amputation; care needs for reintegration to life: an integrative review. Int J Orthop Trauma Nurs. 2020; 38100773 PubMed Google Scholar , 10 Zeiler KJ Zeiler FA. Social determinants of traumatic brain injury in the North American Indigenous population: a review. Can J Neurol Sci. 2017; 44: 525-531 Crossref PubMed Scopus (11) Google Scholar , 11 Rethorn ZD Cook C Reneker JC. Social determinants of health: if you aren't measuring them, you aren't seeing the big picture. J Orthop Sports Phys Ther. 2019; 49: 872-874 Crossref PubMed Scopus (22) Google Scholar , 12 Frier A Barnett F Devine S Barker R. Understanding disability and the 'social determinants of health': how does disability affect peoples' social determinants of health?. Disabil Rehabil. 2018; 40: 538-547 Crossref PubMed Scopus (38) Google Scholar Unmet social needs are exacerbated by illness, injury, the acquisition of a disability or a decline in physical functioning that may change one's employment, income, housing, and transportations statuses. 12 Frier A Barnett F Devine S Barker R. Understanding disability and the 'social determinants of health': how does disability affect peoples' social determinants of health?. Disabil Rehabil. 2018; 40: 538-547 Crossref PubMed Scopus (38) Google Scholar Studies estimate that 46%-78% of people with disability, major complex chronic conditions, or frailty have unmet social needs including financial barriers (affording food or housing) and lack of transportation. 6 Huffstetler E, Quincy L. Addressing the unmet medical and social needs of complex patients. Available at:https://www.healthcarevaluehub.org/advocate-resources/publications/addressing-unmet-medical-and-social-needs-complex-patients. Accessed October 25, 2021. Google Scholar ,10 Zeiler KJ Zeiler FA. Social determinants of traumatic brain injury in the North American Indigenous population: a review. Can J Neurol Sci. 2017; 44: 525-531 Crossref PubMed Scopus (11) Google Scholar ,13 Shah NR, Rogers AJ, Kanter MH. Health care that targets unmet social needs. NEJM Catal Innov Care Deliv 2016;2. Google Scholar Global attention to SDOH has led to recommendations for health care systems to more deliberately be involved in addressing patients’ needs. 14 National Academies of Sciences, Engineering, and MedicineIntegrating social care into the delivery of health care: moving upstream to improve the nation's health. National Academies Press, Washington (DC)2019 Google Scholar It is critical that rehabilitation services align with national recommendations.