January observance considers poverty, social determinants of health in America
By Dennis Archambault
This month, health equity and human service advocates throughout the country are reminding elected officials, health administrators, and average citizens that aspects of daily living – food, housing, transportation – and systemic factors such as environmental quality, social violence and public safety, and education influence health directly or indirectly. They’re known as “social determinants” of health, but many prefer “social drivers” because individual will power, community organizing, and political advocacy can overcome social influences.
To that last point, Daniel Dawes and other health policy experts have viewed the “political determinants” of health as overshadowing influences on the social determinants. Poorly crafted and administered social policy – or policy, through design, that negatively affects health, deliberately or not – can be influenced by social action, from the local level to the state and national level. Elected officials and their policy staff need to understand how bad policy affects health – and, conversely, how good social policy promotes health. In an era of increasingly limited spending on social problems, advocates need to explain the impact of their programs on the constituency of the elected official to convince them to help move a spending bill forward.
Medical residents at Authority Health have an opportunity to step away from the hands-on medical care of patients to examine how a lack of transportation, poor literacy, hunger and malnutrition, and environmental pollution affects the health of their patients – and how they can use their limited free time and finances, but great social influence, to help change social policy. Dr. Danielle Rehal, a Family Medicine resident, went to Washington with Authority Health leadership to promote the importance of training primary care physicians in underserved communities, among other aspects of her advocacy rotation month. Dr. Oluchi Anuniru, also a Family Medicine physician, will pursue her advocacy rotation in March. This is one of the ways that Authority Health and its teaching health center add value to the training of primary care physicians.
Appropriately, January is also “National Poverty in America Awareness Month.” Slightly more than 11 percent of the American population is living in poverty – which is a household income of $30,000 for a family of four, or $14,500 for an individual. Poverty, of course, influences the social determinants of health. Likewise, many social determinants prevent people from getting out of poverty.
Later this month, our Albert Schweitzer Fellows, along with Americans nationwide, will be dedicating a day of service in commemoration of the Martin Luther King, Jr., Day of Service, Jan. 20. While the service may be well-intended, in the context of the social determinants of health and system influences, the Schweitzer Fellows will consider the question: “Can we provide social service and work for social change? Or do our efforts to provide human services maintain or even strengthen social inequality.”
This is an important consideration for sustainable health improvement, leading to health equity.
Dennis Archambault is vice president of Public Affairs for Authority Health.