Social Determinants of Health and the Hospitalized Child.

Abstract

KP, a 2.5-year-old infant with cachexia, recently was admitted to our hospital. A year ago, the hospitalist team treated her for sequelae of Zika virus exposure: microcephaly, central diabetes insipidus, and failure to thrive. Sadly, here she was again, weighing less than her discharge weight when she was 18 months old. Her standardized weight for age had plummeted from an already poor −2.5 to an abysmal −5.5. How had our medical system failed this child? KP’s mother had dual US and Dominican citizenship, but was homeless and lacking many social supports in the United States. When her medically complex child was born, her social safety net collapsed. She realized she could not continue to bounce around between homes with such a medically fragile child. She had applied for Section 8 housing but had no idea when it would be approved, so she did the only thing that seemed reasonable: move back to the Dominican Republic to live with her parents. She ran out of desmopressin acetate (DDAVP) for her child in 3 months. She was forced to replace her child’s prescribed formula with powdered milk. She was hospitalized multiple times for aspiration pneumonia. KP returned to the United States with her mother, malnourished and weak, when their housing voucher was approved. Her health had dramatically declined, all because of housing insecurity and other key social determinants of health (SDOH). SDOH are “conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”1 There is some variability in opinion on what constitutes the SDOH roster, but the determinants generally include economic stability, education, social and community context, health and health care, neighborhood and built environment, limited English proficiency, immigration status, transportation barriers, racism and bias, household …