What is the role of a health care provider? The ultimate goal of a health care provider is to keep an individual and community healthy. What is the definition of health and wellness? In simple terms, health means the mere absence of disease. Wellness means deliberate choices chosen by an individual that leads to a holistic state of health. It is multidimensional. It includes an optimal balance between physical, emotional, psychological, occupational, spiritual, and social states. Four factors play a vital role in an individual’s health-social, lifestyle, genetics, and health care delivery system.
Social determinants are defined by the physical environment in which a person is born, raised, and spends time. It includes access to housing, employment, transport, air/water quality, socioeconomic status, education levels, social networks, and childhood years. In short, health begins with access to economic and social opportunities. Two studies from the UK report that an individual’s position on a social ladder shows a direct correlation with the longevity and quality of a person’s life. Animal studies corroborated with it.
Social determinants explain mostly health care disparities. In the US, Hispanic females live 14 years longer than African American males. A similar difference exists between rich and poor Americans. To illustrate the point, think of two males (black and white) who are head of the academic departments. Two are similarly situated on the academic ladder but are differently positioned on the societal level. The black person is under constant stress resulting in high cortisol levels that weaken the immune and cardiovascular system resulting in premature death.
To emphasize the effects of social determinants, WHO recommended “Closing the gap in a generation: Health equity through action on the social determinants of health” and “health in all policies (HIAP)”. “Healthy People 2020” emphasizes and addresses social issues and equitable health in the US. To reduce health care disparities, health initiatives like “National Partnership for Action to End Health Disparities and the National Prevention and Health Promotion Strategy” were created.
Access to insurance and the health care system is not sufficient. Access to housing, transportation, healthy food, and recreational parks is essential. Simply counseling about diet and exercise is not enough. Our interaction with the patients should include taking a comprehensive social history. Based on individual circumstances, a customized medical care plan should be devised. More importantly, avoiding judging a person’s social situation helps build trust and rapport between the patient and the physician resulting in better outcomes. It is imperative in the ballooning health care environment to understand the social status and educate patients about the resources, support, and networks available in the community.
