Social Determinants of Health, what are they?
While you may not think about it, there is a whole lot more that affects your health than merely what happens in the doctor’s office. All aspects of a person’s life end up contributing to their health beyond the healthcare system, some of them quite detrimental. Social Determinants of Health (SDOH) are the, “conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of-life risks and outcomes” according to the CDC. They are the economic, cultural, and social factors that impact a person’s health. SDOH consists of five domains; economic stability, education level, neighborhood environment, social and community context, as well as personal health and access to healthcare. These interrelated factors have a profound impact on a person’s health but may not be thought of at first glance. SDOH requires a more holistic view of the patient and their life outside of the doctor’s office, hospital, or clinic. Broader questions must be examined to determine the status of an individual’s health and if they will be able to maintain optimal health against the obstacles/stressors in their daily life.
Do Social Determinants of Health come into play after a TBI?
Let’s imagine that a person suffers a traumatic brain injury – we’ll call her Maria. After falling down a set of concrete stairs and hitting her head, the first barrier that Maria will face is if her brain injury is even diagnosed. Maria doesn’t have health insurance, so a trip to the hospital could be prohibitively expensive and something she’ll likely want to avoid. What if Maria also does not realize the severity of her injury or that she even needs to make a trip to the hospital? This could happen if Maria’s health literacy is low due to her exposure and upbringing. This could make it harder for her to know when an injury requires a trip to the hospital and even if she makes it to the hospital it may be challenging for her to make informed health decisions. On top of this, traumatic brain injuries without external markings can be easily missed by those not familiar with the symptoms of a TBI. Lacking a clear external injury, Maria may elect to skip medical attention. Travel is also an issue for Maria since she lives in a rural location where the nearest hospital is over an hour away. In general, Maria’s social circle overlooks medical care, minimizing Maria’s injuries, and convincing her that she does not need care. All of the determinants of health are highly contextual and embedded in a person’s everyday life; in Maria’s case, they are functioning as roadblocks for proper diagnosis and treatment of her TBI.
Assuming that Maria does get to the hospital and sees a doctor, what will be the quality of the care she receives? What if she is discriminated against due to her race, ethnicity, language, economic, or immigration status? Even if she does get the proper diagnosis, Maria may come from a culture or community that distrusts doctors due to historical trauma, meaning she might not listen to medical advice or pursue recommended treatment. Furthermore, how will Maria’s care be impacted if she returns home to an underfunded and overworked community health clinic? Maria may find that she has inadequate familial or social support to continue her course of treatment and follow-up visits. Social Determinants of Health need to be factored in and addressed if Maria is going to get the care she needs after her TBI.
There are many real people struggling with issues similar to Maria, so recognizing and dealing with Social Determinants of Health is a major ongoing challenge to recovery from a traumatic brain injury. Because our lives are so individualized in many ways, it is important that the care one receives after getting a TBI reflects the stressors or challenges that they face outside of the doctor’s office. This is where Power of Patients comes in. We believe understanding the different factors at play following a TBI is the key to recovery and/or symptom management, and that is why we created the Dashboard. Social determinants of health can be triggers for TBI symptoms, and it is important for patients to have the ability to know what circumstances exacerbate their symptoms. The Power of Patients Dashboard was designed with a section exactly for this purpose; to identify triggers and symptoms specific to SDOH. By tracking symptoms, a TBI patient is more able to identify the aspects or places within their lives that heighten their pain.
Taking a step back to look at a more complete, holistic view of the patients leads to not only more awareness but better outcomes. If barriers to care and roadblocks to recovery can be pinpointed early, this gives patients a better chance at recovery. Identifying all the factors that come into play with a patient’s health, even before they reach the doctor’s office is critical for improving care and outcomes for TBI patients.