Thinking about the Social Determinants of Health

Dr Crook EditedAt the end of November 2017, Dr. Errol Crook, Director of the Center for Healthy Communities and the Abraham Mitchell Chair of Internal Medicine at the USA College of Medicine, gave a presentation during Internal Medicine Grand Rounds on “The Social Determinants of Health: A Focus on Poverty.” Dr. Crook started by saying that he wanted to talk more about public health than focusing on one patient. Through the presentation, he explored:

  • Health equity and health disparities
  • Discussed socio-cultural determinants of health in the U.S. (and the world)
  • Reviewed the impact of poverty on health
  • Examined the importance of understanding how social factors may impact care of individual patients

Poverty in contextIn the discussion on poverty, Dr. Crook explained the importance of context and understanding that

  • Having an income does not remove the risk of poverty
  • Wealth and income are different as a person may have income but not the accumulated wealth to cover emergency expenses such as unforeseen health issues
  • People living in poverty usually work many hours and many jobs.

In other words, for people living in poverty or near it, health care and education costs are discretionary expenses. They have to decide between buying medication or seeking care and paying for gas to get to work.

With that background, he introduced two projects from the Center for Healthy Communities. First, The Impact of Labor Force/Labor Market Status On Access To Health Care with Dr. Kenneth Hudson as Principal Investigator explored the relationship between job types (good job, mediocre job, or bad job) and health. The study looked at a random sample of households in census tracts in Mobile, AL, with at least 50% of residents living at or below the federal poverty line. Dr. Hudson and his team found that

  • 91.5% of respondents were working
  • The majority of respondents were in bad jobs — those without health or retirement benefits and paying poverty wages
  • The participants spent a large percentage of income on basics such as rent and utilities
  • For those who did not acquire a job with health insurance or retirement benefits before the age of the 30, the most likely never would.

Dr. Crook also talked about the importance of data from The Sentinel Surveillance to Monitor Progress Towards Health Equity with Dr. Martha Arrieta as Principal Investigator. Given the difficulty of obtaining good information on the health status of individuals living in low-resource areas, the project used a sentinel surveillance approach to choose data collection sites that intersected with the daily lives of residents in three high poverty zip codes in Mobile, AL. The research produced a lot of information on the number of people below the age of 65 reporting having chronic diseases such as diabetes and high blood pressure. Dr. Crook emphasized that 68% of those responding to the survey felt that diabetes would result in severe complications regardless of what treatment or lifestyle changes a person underwent.

Dr. Crook closed his presentation by drawing together the threads of social factors, income and wealth disparities, employment status, and attitudes toward health into a single pattern focused on an individual patient and her health needs. He asked those attending to think about the patient’s future prospects based on what her educational and socio-economic status were. He encouraged those working in the clinics to think about these issues as they worked with individuals.

View Dr. Crook’s presentation online.