Social Determinants of Health: The Fifth Vital Sign

Abstract

Introduction Since the last decade, social determinants of health (SDOH) have become a vital component of the liturgy of public health. From that time, the number of articles on SDOH cited in PubMed has increased from approximately 775 to over 4,700.

Issue In obstetrics, social determinants of health have particular resonance in discussions of maternal mortality and health disparities and the number of articles on SDOH in obstetrics has increased sixfold during the same interval. However, while most obstetricians are now aware of SDOH, many are unsure about how to address them within the context of their own practice.

Summary In this piece, we will discuss the importance of SDOH in obstetrics, the reasons why most obstetricians have not engaged with it and suggest steps to help bridge the gap between merely accepting SDOH's importance and implementing strategies to mitigate their effects.

Key Points

• Obstetricians believe SDOH can lead to adverse outcomes but few feel confident addressing social needs.

• Three suggested steps in addressing SDOH are identifying needs, identifying resources, and then linking the two.

• Organizations are as vital as individual physicians in implementing strategies to address SDOH.

Keywords

health disparities - public health - social determinants of health - social disadvantage

• References

• 1 Centers for Disease Control and Prevention. Social Determinants of Health: Know What Affects Health. Accessed October 15, 2021 at: https://www.cdc.gov/socialdeterminants/index.htm
• 2 Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Accessed October 15, 2021 at: https://health.gov/healthypeople/objectives-and-data/social-determinants-health
• 3 AAFP. (n.d.). Addressing social determinants of health in primary care: Team-based approach for advancing health equity. Accessed June 27, 2021 at: https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/team-based-approach.pdf
• 4 McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med 1998; 338 (03) 171-179
• 5 Fenton J. Health care's blind side. Robert Wood Johnson Foundation; 2011; https://www.rwjf.org/en/library/research/2011/12/health-care-s-blind-side.html
• 6 World Health Organization. Social determinants of health. Accessed October 15, 2021 at: https://www.who.int/teams/social-determinants-of-health
• 7 AAFP. (2018, July 18). Neighborhood navigator. Accessed June 27, 2021 at: https://www.aafp.org/patient-care/social-determinants-of-health/everyone-project/neighborhood-navigator.html
• 8 Committee on the Recommended Social and Behavioral Domains and Measures for Electronic Health Records, Board on Population Health and Public Health Practice, Institute of Medicine. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. Washington, DC: National Academies Press; 2015. Jan 8.
• 9 NACCHO. (n.d.). Directory of Local Health Departments. Accessed August 6, 2020 at: https://www.naccho.org/membership/lhd-directory
• 10 The EveryONE project. Accessed June 27, 2021 at: https://www.aafp.org/family-physician/patient-care/the-everyone-project/toolkit.html
• 11 The American College of Obstetricians and Gynecologists. Safe Motherhood Initiative, Severe Hypertension. Accessed October 15, 2021 at: https://www.acog.org/community/districts-and-sections/district-ii/programs-and-resources/safe-motherhood-initiative/severe-hypertension
• 12 County Heath & Roadmaps. Growing community power to improve health equity. Accessed June 27, 2021 at: https://www.countyhealthrankings.org/
• 13 HealthLandscape. Accessed June 27, 2021 at: https://healthlandscape.org/
• 14 NowPow. . Accessed August 6, 2021 at: www.nowpow.com