Making the social determinants of health a routine part of medical care.

Abstract

people live: where they are born, grow up, work, and age. These conditions affect a person's health and vulnerability to disease, and very often vary by wealth, social status and gender. While all health practitioners have the potential to address socioeconomic status as a contributor to suboptimal health status, providers working in underserved communities are keenly familiar with the imperative to address the social determinants of health for their patients. Though the ethical and clinical imperatives to address these issues is appreciated by many, screening for conditions takes time, and the reality of limited time often competes with the urgency of a clinic visit or other evidence- based interventions delivered by the health care team at the time of an encounter. Therefore, screening for socioeconomic determinants of health, like many other routine clinical care tasks, must be as brief and evidence- based as possible, and shared by all members of the health care team. 3 The use of technology via clinical decision support systems (CDSS) to help the team remember to perform routine tasks has been shown to improve screening for many conditions, 4 and their use can also assist with screening for socioeconomic determinants of health. Finally, as is the case for any condition that is screened, a bona fide interven- tion should be available to address a positive screen. Using these overarching principles of thorough and efficient team- based care, a comprehensive system to screen for several socioeconomic determinants was implemented for an entire health center population. This ACU Column focuses on Norwalk Community Health Center's (NCHC's) adoption of diagnostic screening tools to detect relevant information in the fields of housing, intimate partner violence, alcohol misuse, illicit substance misuse, tobacco use, sexual activity, and mental health/ depression. By screening every patient with evidence- based, validated screening tools, NCHC reaffirms the importance of detecting social factors that determine risk for illnesses and can have profound influence on treatment.